Palatal Lift Research Articles

中咽頭癌術後に生じた鼻咽腔閉鎖機能不全に対しbulb-PLPを適応した1例

中咽頭癌切除後に生じる鼻咽腔閉鎖不全に伴う嚥下障害，構音障害に対し口腔内装置を用いることにより早期の機能回復が期待できる。われわれは中咽頭癌切除後に生じた嚥下障害，構音障害に対し，bulb-PLPを用いて良好な回復を得た症例を経験した。症例は73歳男性。他科で中咽頭癌（T2N1M0）の診断で右軟口蓋および扁桃を切除し，舌弁による再建が施行されたが，食塊の鼻腔流入，開鼻声を認めたため，口腔内装置での改善を目的に当科を受診した，側方X線規格写真では，/i:/発音時の軟口蓋の挙上は口蓋平面に達しておらず，咽頭後壁との間隙を認めた。発話は開鼻声で開鼻声値は40%を超えていた。鼻咽腔閉鎖不全と診断し，軟口蓋挙上と閉鎖不全部の補填を目的にbulb-PLPを作製した。装着後，食塊を咽頭に送り込めるようになり，開鼻声は改善，開鼻声値は20%以下となった。中咽頭癌術後の機能回復には軟組織再建の他，口腔内装置も有用と考える。

Palatal lifting prosthesis and velopharyngeal insufficiency: Preliminary report

Our study aimed to highlight the effectiveness of palatal lift prosthesis in patients with velopharyngeal insufficiency with previous operated cleft palate. This study was done undertaken January 2008 to December of 2009 in the Phoniatic unit of Alnoor Specialist Hospital, Makkah, Saudi Arabia. Ten patients of ≥ 8 years to ≤ 10 years of age, who had previously undergone surgery for cleft palate, with or without cleft lip, with no other systemic illness and normal intelligent quotient level, were selected and managed by palatal lift prosthesis. All the study subjects were subjected to auditory perceptual speech evaluation for assessment of the degree of hypernasality, compensatory articulator mechanisms, glottal and pharyngeal articulation, audible nasal emission, facial grimace and overall intelligibility of speech. Data were analyzed using SPSS version 16. The study included 10 subjects whose mean ± standard deviation of age was (8.9±0.9). On auditory speech perceptual evaluation after prosthesis application, significant improvement was found in glottal articulation 6 (85.7%), p=0.04, facial grimace 6 (85.7%) p=0.04, hyper nasality 10 (10%) p=0.008, and speech intelligibility 9 (90%) p=0.008. Young patients with repaired palatal cleft have significant improvement after application of palatal lift prosthesis.

Management of obstructive sleep apnea with a palatal lift prosthesis

Background This case report is presented to demonstrate the effects of a palatal lift prosthesis for the management of mild to moderate obstructive sleep apnea.

栓塞子付き口蓋挙上装置(Bulb-PLP:Bulb attached Palatal Lift Prosthesis)の考案

栓塞子付き口蓋挙上装置(Bulb-PLP:Bulb attached Palatal Lift Prosthesis)の考案

A Simplified Palatal Lift Prosthesis for Neurogenic Velopharyngeal Incompetence

Velopharyngeal incompetence is a contributing factor to speech disorders and implies the presence of hypernasality, inappropriate nasal escape, and decreased air pressure during speech. One prosthetic treatment is a rehabilitative procedure employing a palatal lift prosthesis (PLP), which reduces hypernasality by approximating the incompetent soft palate to the posterior pharyngeal wall and consists of two parts, the anterior denture base and the palatal lifting plate, which are connected with steel wires; however, it seems difficult to reproduce the mobility of the soft palate in speaking, and it is therefore likely that the palatal lifting plate stimulates or oppresses the tissue of the soft palate and hinders rather than assists articulatory function. To avoid these disturbances we devised an adjustable PLP with a flexible conjunction between the denture base and the palatal lifting plate to obtain the optimal vertical lifting angle. The palatal plate was adapted to conform in a passive manner to the soft palate with light-cured resin. The designed PLP simplified the procedure and reduced the number of adjustments and visits.

Prosthetic Rehabilitation of Velopharyngeal Insufficiency: A case of Pharyngeal Obturator with palatal lift prosthesis

Palatal defect of any extent causes multiple problems in speech, mastication and esthetics. Cancer resection is the most common cause of acquired palatal defects. Palatal defect can be repaired by reconstructive surgery and/or a dental prosthesis. A soft palate defect may result from surgical resection, and its consequences could include hypernasal speech and nasal regurgitation of food and liquids. A speech aid prosthesis fabricated for patients can improve nasal emission during speech, and assist in preventing nasal regurgitation of food. This article presents a case of the reconstruction of a soft palate defect by prosthetic obturation.

Implant‐supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report

To describe the use of dental implants in the treatment of velopharyngeal incompetence. Velopharyngeal incompetence is characterized by the inability to contract the tissues of the soft palate. The most common causes are neuromuscular problems resulting from concussion and degenerative conditions of the central nervous system. The treatment using palatal lift prosthesis is well established in the literature; however, reports on the use of osseointegrated implants are scarce. Rehabilitation using only this type of fibromucosal support is difficult in edentulous patients, since the prosthesis has a palatal lift extension. The implants provided retention and stability to the prosthesis, improving swallowing and speech and contributing to improve the patient's quality of life. This article reports the rehabilitation of a patient with a totally edentulous maxilla with velopharyngeal incompetence using an implant-retained palatal lift prosthesis.

Fabricating a Soft Liner-Retained Implant-Supported Palatal Lift Prosthesis for an Edentulous Patient: A Case Report

This case report describes fabrication of a palatal lift prosthesis for a quadriplegic edentulous 30-year-old male with past head traumatic injury. We constructed an implant supported bar and used a soft-lining material for the maxillary palatal lift prosthesis to minimize the possibility of implant overloading and also provide a less complex and less expensive procedure for this patient.

Interim palatal lift prosthesis as a constituent of multidisciplinary approach in the treatment of velopharyngeal incompetence

The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient's compliance and final outcome.

義歯安定剤により軟口蓋挙上装置 (PLP) が装着可能となった無歯顎症例

義歯安定剤により軟口蓋挙上装置 (PLP) が装着可能となった無歯顎症例

Clinical application of palatal lift appliance in velopharyngeal incompetence

The presence of nasal air leak in cleft palate patients with velopharyngeal incompetence leads to characteristic nasal snort. The efficacy of the palatal lift appliance in patients with adequate velopharyngeal tissue with incompetence was tested. Speech quality improved after the wearing of palatal lift appliance. Palatal lift appliances are simple and efficient in reducing the nasal air leak. Ongoing speech therapy is necessary and advised for patients receiving palatal lift.

小脳髄膜腫術後の嚥下障害に対し脂肪注入と軟口蓋挙上装置を併用し経口摂取が可能となった 1 例

小脳髄膜腫術後の嚥下障害に対し脂肪注入と軟口蓋挙上装置を併用し経口摂取が可能となった 1 例

Effects of Bulb Type Palatal Lift Prosthesis Therapy on Nasality and Velopharyngeal Function of Patients Following Palatoplasty

In the present study, the effects of bulb type palatal lift prosthesis (bulb-PLP) therapy on nasality and velopharyngeal function (VPF) of patients with velopharyngeal incompetence (VPI) following palatoplasty were longitudinally assessed.The subjects included 18 patients (3 to 52 years of age) who had shown persistent VPI following palatoplasty and who had received bulb-PLP therapy. Nasality and VPF were assessed by perceptual voice analysis, nasometer test, blowing test, and cephalometric radiographic examination. Based on the outcomes of bulb-PLP therapy, the subjects were classified into two groups: the effective group and the ineffective group. Furthermore, the obturating and VPF-activating effects by bulb-PLP therapy were analyzed, and factors relating to different VPF activities were determined.All subjects achieved adequate VPF by wearing a bulb-PLP. After treatment, 10 patients (55.6%) achieved successful activation of VPF without bulb-PLP (the effective group), while persistent VPI remained in 8 patients (the ineffective group). The beginning-blowing ratio of the effective group was significantly greater than that of the ineffective group (P < 0.05) and the velopharyngeal distance (V-P distance) of the effective group tended to be smaller (P = 0.07). Regarding the shape of the bulb head, the angular type was dominant in the ineffective group, while the round type was dominant in the effective group.Bulb-PLP therapy was useful for providing adequate VPF activation. Possible signs of the subsequent effective activation of VPF are considered to be: 1) preexisting adequate VPF on blowing, 2) smaller V-P distance, and 3) synchronized palatopharyngeal movement.

Effects of palatal lift prosthesis and repushback surgery on velopharyngeal incompetence in cleft palate patients

Effects of palatal lift prosthesis and repushback surgery on velopharyngeal incompetence in cleft palate patients

Effects of Bulb Type Palatal Lift Prosthesis Therapy on Nasality and Velopharyngeal Function of Patients Following Palatoplasty

Effects of Bulb Type Palatal Lift Prosthesis Therapy on Nasality and Velopharyngeal Function of Patients Following Palatoplasty

A Preoperative Appliance for a Newborn with Cleft Palate

Cleft palate is a commonly observed congenital maxillofacial defect. One of the most important problems with clefts is the interference with feeding. An affected infant cannot produce negative pressure in the oral cavity and therefore cannot move the bolus backward to the pharynx. To obtain better nutritional intake prior to surgical correction, a palatal lift obturator is recommended. In this clinical report, a modified technique of obturator fabrication is presented. The new method uses a piece of tulle, a flexible and durable material that is frequently used in theater attire. With the help of this material, the bulb part is connected to the plate as a labile piece, and this connection acts like a natural velopharyngeal extension. Additionally, because of the softer property of the silicone elastomer, the posterior pharyngeal wall is less irritated.

The effect of nasal speaking valve on the speech under experimental velopharyngeal incompetence condition

Velopharyngeal incompetence (VPI) is a contributing factor to speech disorders, frequently accompanying disorders, such as cleft palate, congenital paralysis of the soft palate, and cerebrovascular disease. For the treatment of these types of dysarthria, a Nasal Speaking Valve (NSV), which regulates nasal emission utilizing one-way valve, has been reported to be effective. As the unpleasantness while wearing the NSV was less than that with the conventional Palatal Lift Prosthesis, the NSV could be worn for a longer period of time. As NSV is inserted into the nostrils, this device could easily be provided for edentulous patients. This study aimed to evaluate the effect of NSV on experimentally induced VPI condition. Intelligibility of monosyllabic speech, intelligibility of conversational speech, nasalance score and acoustic analysis were used to evaluate the effect of NSV. Local infiltration anaesthesia was achieved to the area of levator veli palatini muscle and tensor veli palatine muscle of seven adult male subjects. In all subjects, remarkable suppression of the soft palate movement could be observed after the local infiltration anesthesia. Although the utterance supported by NSV under the experimentally induced VPI condition was less natural than the normal utterance, the intelligibility was markedly improved by the device. From the results of this study, the acoustic properties of NSV on the pure VPI condition, which was enabled by the newly established experimental induction, were revealed. This experimental model was also proved to provide a basis for the improvement in the treatment modalities for VPI.

Nasal speaking valve: a device for managing velopharyngeal incompetence1

Velopharyngeal incompetence is a contributing factor for speech disorders, and other frequently accompanying disorders, such as cleft palate, congenital paralysis of the soft palate and cerebrovascular disease. A palatal lift prosthesis (PLP) has been fabricated for managing velopharyngeal incompetence to improve speech. Because of discomfort, such as difficulty in swallowing or vomiting reflex, while wearing the PLP, rigorous adjustment is required. Patients may have difficulty becoming accustomed to using the prosthesis. This article reports on a newly developed device, the nasal speaking valve, for improving hypernasal speech caused by velopharyngeal incompetence.

Stress Velopharyngeal Incompetence: Prevalence, Treatment, and Management Practices

Stress velopharyngeal incompetence is the unwanted coupling of the oral and nasal cavities while brass and woodwind musicians play their instruments. This study investigated both (1) the prevalence of stress velopharyngeal incompetence in college musicians, delineating symptoms and situations possibly associated with the condition; and (2) physicians' experiences with musicians exhibiting stress velopharyngeal incompetence, including typical treatment and management techniques. Questionnaires were distributed to 297 brass or woodwind student musicians at three public universities and to 998 plastic surgeons and otolaryngologists. The musician questionnaire focused on demographic data and identification of symptoms that might indicate the presence of stress velopharyngeal incompetence. The physician questionnaire addressed demographics of the physician and his or her practice, familiarity and experience with stress velopharyngeal incompetence, and treatment and management suggestions for individuals experiencing the condition. Thirty-four percent of the responding musicians reported symptoms of stress velopharyngeal incompetence, most often after 30 minutes of playing. Forty-five percent of the responding physicians reported being familiar with the term stress velopharyngeal incompetence, although only 27% reported ever having seen a patient with the condition. The seven most frequently reported intervention strategies were referral to a speech language pathologist (47.50%), sphincter pharyngoplasty (30.00%), pharyngeal flap (26.88%), referral to a cleft palate team (24.38%), watch and wait (18.75%), posterior wall fat injection (12.50%), and palatal lift (10.00%). Stress velopharyngeal incompetence is a potentially career-ending (or career-preventing) problem that currently may be undertreated and that is in need of more systematic study both in terms of its physiologic underpinnings and its management.

Questionable evidence for the effectiveness of prosthetic treatment in managing velopharyngeal dysfunction1

Q Are prosthetic devices (palatal lift & palatal obturator) effective for managing oronasal resonance and nasal emission in participants with velopharyngeal dysfunction (VPD)? 1 ed from: Sell, D., Mars, M., & Worrell, E. (2006). Process and outcome study of multidisciplinary prosthetic treatment for velopharyngeal dysfunction. International Journal of Language & Communication Disorders, 21, 495–511.