Velopharyngeal Movement Research Articles

Overlapping Intravelar Veloplasty Improves the Speech Outcomes in Submucous Cleft Palate.

Submucous cleft palate (SMCP) is a subgroup of cleft palate that can present as velopharyngeal insufficiency due to muscle displacement. The pharyngeal flap and Furlow palatoplasty have been introduced to correct SMCP patient with velopharyngeal insufficiency. However, pharyngeal flap and Furlow palatoplasty can occur various complications. We consider the overlapping intravelar veloplasty (IVVP) can overcome these complications. Therefore, we present the speech outcomes of overlapping IVVP for the treatment of patients with SMCP. We retrospectively reviewed 12 patients with SMCP underwent overlapping IVVP between April 2016 and October 2018. The patients who underwent speech evaluation, nasometry, and nasoendoscopy before and after surgery and who were followed up for >18 months were enrolled in this study. The average age of the patients was 5 years (range, 3-11 years) and the postoperative follow-up period ranged from 18 to 24 months (mean, 20 months). The preoperative perceptual speech evaluation was moderate and the postoperative evaluation was normal ( P < 0.01). The preoperative and postoperative nasalance scores obtained using a nasometer were 37.00 and 12.50, respectively, ( P < 0.01). Preoperative and postoperative velopharyngeal movements were grades 3 and 0, respectively, ( P < 0.01). Our study showed that overlapping IVVP could provide successful correction of velopharyngeal insufficiency in patients with SMCP, including relatively old patients.

Fiberoptic laryngoscopic neurological examination of amyotrophic lateral sclerosis patients with bulbar symptoms

ObjectiveBulbar symptoms in amyotrophic lateral sclerosis (ALS) are variable, reflecting bulbar and pseudobulbar palsy. The current study sought to characterize the pharyngeal findings in ALS using a fiberoptic laryngoscope and compare them with the findings of general neurological examination. MethodsWe enrolled ALS patients with bulbar symptoms who were admitted between 2014 and 2020. All participants were evaluated on salivary status, velopharyngeal movement during speech and swallowing, pharyngeal constriction, and vocal cord movement using fiberoptic laryngoscopy. The laryngoscopic findings were compared with general neurological examination results. ResultsA total of 50 patients (31 men; median age: 69 years) were enrolled. Salivary residue in the hypopharynx was the most common abnormal finding on laryngoscopy (40 patients; 80%). Twenty-three patients (46%) exhibited velopharyngeal insufficiency, 18 of which exhibited good velopharyngeal closure in swallowing and poor velopharyngeal closure in speech. Thus, these patients presented speech-swallow dissociation (SSD) in velopharyngeal closure. Five patients (10%) exhibited unilateral weakness of the pharyngeal constrictor muscles in phonation. Compared with general neurological examinations, emotional incontinence was more frequent in patients who presented with SSD in velopharyngeal movement, compared with those who did not. None of the five patients with unilateral weakness of pharyngeal constriction showed curtain movement on examination via the mouth. ConclusionThe specific findings of laryngoscopy in ALS patients, such as SSD in velopharyngeal closure and laterality in pharyngeal constriction, could not be evaluated by general neurological examination via the mouth.

A Preliminary Dynamic Investigation on Velopharyngeal Movements During Blowing: A New Approach for Evaluation

To explore an alternative approach to evaluate velopharyngeal function on those speakers with compensatory misarticulation. Nasopharyngeal endoscopy was used to observe the velopharyngeal movement on 26 adult Mandarin speakers during articulation and different nonverbal state, including SCPS, DCPS, and ABS. There were significant differences for the rate of velopharyngeal incompetence (RVPI) among the 4 different states. The RVPI was least for the Articulation State, followed by the Air Blowing and DCPS. The RVPI was largest for the SCPS. The result indicated that the ABS may be used as an alternative approach to evaluate the velopharyngeal function instead of the articulation samples while patients cannot make clear articulation due to compensatory misarticulation habits. It merits further study on nonverbal activities, which could lay a foundation for exploring more effective approach for evaluation of the velopharyngeal function.

Opinions of Speech-Language Pathologists Regarding Speech Management for Children With Cleft Lip and Palate

The purpose of the present study was to examine practice patterns and opinions that speech-language pathologists (SLPs) have about speech-language intervention for children with cleft lip and palate. One hundred seven speech-language pathology members of the American Speech-Language-Hearing Association Special Interest Group 5: Craniofacial and Velopharyngeal Disorders Special Interest Group completed a 37-item online survey that examined common practices in early intervention as well as opinions about speech characteristics, assessment, and management strategies for children with cleft lip and palate. The overwhelming majority of respondents (96%) agreed that speech-language pathologists (SLPs) should meet with parents before palatal surgery to discuss speech-language issues. Although 90% of the SLPs identified increasing consonant inventory as an early intervention goal, lack of consensus was evident regarding the type of consonant to stimulate. Respondents agreed that while blowing activities are not useful in strengthening labial, lingual, or velopharyngeal movements, they are useful in heightening awareness of oral airflow for children with cleft palate. A large degree of variability was evident in opinions regarding prevalence and treatment of compensatory articulations as well as the effectiveness of treatment strategies designed to reduce perceived hypernasality and audible nasal emission. The findings of this study indicate a large degree of variability in opinions of SLP respondents regarding assessment and treatment of children with cleft lip and palate.

Quantitative Analysis of Velopharyngeal Movement by Applying Principal Component Analysis to Range Images Produced by a Three-Dimensional Endoscope.

Objectives: The purpose of this study was to develop a new technique for analyzing velopharyngeal movement and to investigate its utility. Materials and Methods: Velopharyngeal motion of 20 normal individuals was analyzed. A three-dimensional (3D) endoscope was inserted into the oral cavity, and the movement of the soft palate was measured using an exclusive fixation device. Range images of the soft palate were produced during phonation of the Japanese vowel /a/, and virtual grids were then overlaid on these images. Principal component analyses were applied to the 3D coordinates of the intersections of the virtual grids. The centers of gravity of the virtual grids were calculated, and the magnitude of the shift of the grid intersections during phonation was calculated. Results: The first and the second principal component scores were responsible for the upper posterior direction and the upper direction, respectively. The average magnitude of the shift of the center of gravity was 4.75 mm in males and 4.33 mm in females. Conclusions: Quantitative analysis of velopharyngeal movement was achieved by a method of applying principal component analysis (PCA) to the range images obtained from a 3D endoscope. There was no sex difference in velopharyngeal movement.

Using Synchronized Audio Mapping to Track and Predict Velar and Pharyngeal Wall Locations during Dynamic MRI Sequences

Purpose : The purpose of this study is to demonstrate a novel innovative computational modeling technique to 1) track velar and pharyngeal wall movement from dynamic MRI data and to 2) examine the utility of using recorded participant audio signals to estimate velar and pharyngeal wall movement during a speech task. A series of dynamic MRI data and audio acoustic features were used to develop and inform a Hidden Markov Model (HMM) and Mel-Frequency Cepstral Coefficients (MFCC) model. Methods : One adult male subject was imaged using a fast-gradient echo Fast Low Angle Shot (FLASH) multi-shot spiral technique to acquire 15.8 frames per second (fps) of the midsagittal image plane during the production of “ansa.” The nasal surface of the velum and the posterior pharyngeal wall was identified and marked using a novel pixel selection method. The error rate was measured by calculating the accumulation error and through visual inspection. Results : The proposed model traced and animated dynamic articulators during the speech process in real-time with an overall accuracy of 81% considering one pixel threshold. The predicted markers (pixels) segmented the structures of interest in the velopharyngeal area and were able to successfully predict the velar and pharyngeal configurations when provided with the audio signal. Conclusion : This study demonstrates a novel and innovative approach to tracking dynamic velopharyngeal movements. Discussion of the potential application of a predictive model that relies on audio signals to detect the presence of a velopharyngeal gap is discussed.

Quantitative analysis of velopharyngeal movement using a stereoendoscope: accuracy and reliability of range images

Objective: We developed a novel method of producing accurate range images of the velopharynx using a three-dimensional (3D) endoscope to obtain detailed measurements of velopharyngeal movements. The purpose of the present study was to determine the relationship between the distance from the endoscope to an object, elucidate the measurement accuracy along the temporal axes, and determine the degree of blurring when using a jig to fix the endoscope. Methods: An endoscopic measuring system was developed in which a pattern projection system was incorporated into a commercially available 3D endoscope. After correcting the distortion of the camera images, range images were produced using pattern projection to achieve stereo matching. Graph paper was used to measure the appropriate distance from the camera to an object, the mesial buccal cusp of the right maxillary first molar was measured to clarify the range image stability, and an electric actuator was used to evaluate the measurement accuracy along the temporal axes. Results: The measurement error was substantial when the distance from the camera to the subject was >6.5 cm. The standard error of the 3D coordinate value produced from 30 frames was within 0.1 mm (range, 0.01–0.08 mm). The measurement error of the temporal axes was 9.16% in the horizontal direction and 9.27% in the vertical direction. Conclusion: The optimal distance from the camera to an object is <6.5 cm. The present endoscopic measuring system can provide stable range images of the velopharynx when using an appropriate fixation method and enables quantitative analysis of velopharyngeal movements.

Technical advances toward an endoscopic-phototransducer approach to investigation of velopharyngeal physiology.

This study aimed to examine the response characteristics of a new generation phototransducer and to test new recording and processing procedures when used with endoscopy to track velopharyngeal closure during normal speech. Integrated phototransducer-endoscopy response linearity was laboratory tested using a wide range of simulated velopharyngeal orifice areas. In vivo speech testing was completed to determine the effect of endoscope to light receptor distance on measurements documenting variations in normal velopharyngeal closure. Phototransducer response linearity was excellent (r = .99) provided an indirect (reflected light) orientation was used between the endoscope and the light-sensing fiber coupled with the phototransducer. Phototransducer response time exceeded expected velopharyngeal movement rates by an order of magnitude. In vivo speech measurements were affected by the distance between the light-emitting endoscope and the light-receiving tip of the light-sensing fiber. Data normalization to a light-out condition effectively controlled for this expected phenomenon. Patterns of velopharyngeal valving during speech were found to be stable and appropriate given the phonetic content of the utterance. Technological and data-processing advances support further exploration of an integrated phototransducer-endoscopic approach to studying velopharyngeal closure for speech. Additional studies involving normal speakers are under way.

鼻咽腔内視鏡ビデオ(NPF-Video)を用いた鼻咽腔運動分析に関して

鼻咽腔内視鏡ビデオ(NPF-Video)を用いた鼻咽腔運動分析に関して

Effects of errorless learning on the acquisition of velopharyngeal movement control

The implicit motor learning literature suggests a benefit for learning if errors are minimized during practice. This study investigated whether the same principle holds for learning velopharyngeal movement control. Normal speaking participants learned to produce hypernasal speech in either an errorless learning condition (in which the possibility for errors was limited) or an errorful learning condition (in which the possibility for errors was not limited). Nasality level of the participants' speech was measured by nasometer and reflected by nasalance scores (in %). Errorless learners practiced producing hypernasal speech with a threshold nasalance score of 10% at the beginning, which gradually increased to a threshold of 50% at the end. The same set of threshold targets were presented to errorful learners but in a reversed order. Errors were defined by the proportion of speech with a nasalance score below the threshold. The results showed that, relative to errorful learners, errorless learners displayed fewer errors (50.7% vs. 17.7%) and a higher mean nasalance score (31.3% vs. 46.7%) during the acquisition phase. Furthermore, errorless learners outperformed errorful learners in both retention and novel transfer tests. Acknowledgment: Supported by The University of Hong Kong Strategic Research Theme for Sciences of Learning

Variability of oronasal coupling in children and adults

Oronasal coupling in young children remains poorly understood primarily because of experimental challenges associated with non-invasive techniques for transducing velopharyngeal movement. Productions of the word [bama] were studied in children with normal speech acquisition (NSA) and children with speech delay (SD; 3-to-5 years of age) with respect to adults. Nasal vibration was transduced using a small, lightweight accelerometer affixed to the lateral alar cartilage of the participant’s nose. The variability in the nasal acceleration signals obtained for multiple productions of the stimuli for each participant was described using the spatiotemporal index (STI) and functional data analysis (FDA). The spatiotemporal index served as a composite method of variability following linear time normalization of the signals. The FDA technique involving nonlinear time normalization allowed for independent evaluation of amplitude and phase variability. The two groups of children with NSA and SD were more variable than the adults on both measures of STI and amplitude variability, while the amount of phase variability was similar between children and adults. These methods have complementary merits and potential in revealing the properties of development and disruption of oronasal coupling in children and adults. [Work supported by NIH-NIDCD.]

Positive Narrowing Pharyngoplasty with Forearm Flap for Functional Restoration after Extensive Soft Palate Resection

The restoration of velopharyngeal function after extensive soft palate resection to treat malignant oropharyngeal tumors is a major challenge to reconstructive surgeons. The authors had previously reconstructed soft palatal defects routinely with the folded forearm flap. A patient who had more than half of the soft palate excised experienced postoperative velopharyngeal dysfunction. To restore efficient velopharyngeal function, pharyngoplasty was additively applied where the folded ridge of the forearm flap was sutured to the posterior pharyngeal wall in an inverse manner of the pharyngeal flap technique. The essence of the procedure was positive narrowing of the nasopharyngeal space. Five patients who underwent this pharyngoplasty and another five who did not were evaluated for postoperative functions of speech intelligibility and of nasal regurgitation during oral feeding. The velopharyngeal movements of all patients were examined under a nasopharyngeal endoscope. The evaluations demonstrated that this surgical procedure afforded satisfactory results. This positive narrowing pharyngoplasty technique is simple, easy, and minimally invasive to the remaining healthy tissue, and it is the method of choice for the reconstruction of the soft palate after malignant tumor resection.

Velopharyngeal closure pattern exerted by contraction of the pharyngeal constrictor muscle in dogs.

This study was performed to investigate aspects of velopharyngeal closure demonstrated by movements of the parapharyngeal wall under various physiological conditions and especially the stimulation of several intrapneumonal receptors. Fifteen mongrel dogs were anesthetized and a nasopharyngeal fiberscope was inserted from the oronasal fistula at the center of the hard palate, with the tip fixed around the choana. Mechanical and chemical stimulation was applied, and ongoing velopharyngeal movements were observed. In each case examined, the muscle nerve located under the bilateral levator veli palatini (LVP) was severed. Two different closure patterns were recognized between rebreathing and deglutition. Chemical stimulation of the pulmonary irritant receptor and type-J receptor induced a sphincteric tight closure of the velopharynx but only a weak inward movement of the lateral pharyngeal wall at lung inflation. The movements of the parapharyngeal wall, mainly represented by the pharyngeal constrictor muscle's contraction, are facilitated as a sphincteric velopharyngeal closure under reflexive movements such as deglutition or gagging.

Velopharyngeal Closure Pattern Exerted by Contraction of the Pharyngeal Constrictor Muscle in Dogs

Abstract Objective: This study was performed to investigate aspects of velopharyngeal closure demonstrated by movements of the parapharyngeal wall under various physiological conditions and especially the stimulation of several intrapneumonal receptors. Materials and Methods: Fifteen mongrel dogs were anesthetized and a nasopharyngeal fiberscope was inserted from the oronasal fistula at the center of the hard palate, with the tip fixed around the choana. Mechanical and chemical stimulation was applied, and ongoing velopharyngeal movements were observed. In each case examined, the muscle nerve located under the bilateral levator veli palatini (LVP) was severed. Results: Two different closure patterns were recognized between rebreathing and deglutition. Chemical stimulation of the pulmonary irritant receptor and type-J receptor induced a sphincteric tight closure of the velopharynx but only a weak inward movement of the lateral pharyngeal wall at lung inflation. Conclusion: The movements of the parapharynge...

Study on Velopharyngeal Movement and Speech Articulation Following Maxillectomy

Study on Velopharyngeal Movement and Speech Articulation Following Maxillectomy

A fiberscopic analysis of velopharyngeal movement before and after primary palatoplasty in cleft palate infants.

There have been few studies done on the abnormal function of velopharyngeal muscles in unrepaired cleft palate infants. To examine and assess velopharyngeal movement before primary palatoplasty offers supposedly any valuable information for the successful operation and the restoration of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatoplasty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrepaired cleft palate infants when crying or strangulation reflex occurred: (1) posterior movement type (10 cases, 38.5 percent), where the soft palates moved only posteriorly and cephalically and did not move medially; (2) medial movement type (10 cases, 38.5 percent), where the soft palates moved only medially and did not move posteriorly or cephalically; and (3) posteromedial movement type (6 cases, 23.0 percent), where the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into three patterns: (1) the soft palate type, in which the soft palate mainly operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) the mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velopharyngeal movement before and after primary palatoplasty in cleft palate infants. In total, 10 of 16 cleft palate infants with the posterior movement type or posteromedial movement type, in which posterior movement of the soft palates was observed before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. On the other hand, only 2 of 10 cleft palate infants with the medial movement type, in which the soft palates did not move posteriorly but medially before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. The Fisher's exact probability test clarified that cleft palate infants with the posterior movement type or posteromedial movement type were more likely to show postoperatively the soft palate type of the velopharyngeal closure compared with those with the medial movement type (p = 0.051). This is the first trial to examine velopharyngeal movement in unrepaired cleft palate infants. Our findings indicate the probability that velopharyngeal closure mechanism in repaired cleft palate infants is able to be predicted by velopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movement and postoperative velopharyngeal function and speech outcome.

A Fiberscopic Analysis of Velopharyngeal Movement before and after Primary Palatoplasty in Cleft Palate Infants

There have been few studies done on the abnormal function of velopharyngeal muscles in unrepaired cleft palate infants. To examine and assess velopharyngeal movement before primary palatoplasty offers supposedly any valuable information for the successful operation and the restoration of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatoplasty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrepaired cleft palate infants when crying or strangulation reflex occurred: (1) posterior movement type (10 cases, 38.5 percent), where the soft palates moved only posteriorly and cephalically and did not move medially; (2) medial movement type (10 cases, 38.5 percent), where the soft palates moved only medially and did not move posteriorly or cephalically; and (3) posteromedial movement type (6 cases, 23.0 percent), where the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into three patterns: (1) the soft palate type, in which the soft palate mainly operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) the mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velopharyngeal movement before and after primary palatoplasty in cleft palate infants. In total, 10 of 16 cleft palate infants with the posterior movement type or posteromedial movement type, in which posterior movement of the soft palates was observed before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. On the other hand, only 2 of 10 cleft palate infants with the medial movement type, in which the soft palates did not move posteriorly but medially before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. The Fisher's exact probability test clarified that cleft palate infants with the posterior movement type or posteromedial movement type were more likely to show postoperatively the soft palate type of the velopharyngeal closure compared with those with the medial movement type (p = 0.051). This is the first trial to examine velopharyngeal movement in unrepaired cleft palate infants. Our Findings indicate the probability that velopharyngeal closure mechanism in repaired cleft palate infants is able to be predicted by velopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movement and postoperative velopharyngeal function and speech outcome. (Plast. Reconstr. Surg. 102: 668, 1998.)

Objective, noninvasive evaluation of velopharyngeal function in cleft and noncleft patients.

The purpose of this study was to investigate a new diagnostic method that provides an approach to noninvasive, objective measurement of velopharyngeal movement by acoustic determination of epipharyngeal volume changes with velopharyngeal muscle function. This was a case control study, using consecutive samples. This study took place at the Cleft Palate Rehabilitation Center of the University of Mainz, Germany. Subjects were 29 consecutive cleft lip and palate (CLP) patients and 31 controls (21 patients with dysgnathia and 10 healthy volunteers). A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 milliseconds) of epipharyngeal volume were performed with the pharyngeal muscles relaxed in end-expiration and while the velopharyngeal orifice was closed, with the difference in volume representing maximal pharyngeal movement. Cleft palate patients yielded significantly lower values of velopharyngeal movement (6.5 cm3) than did the control group (8.0 cm3) (p < .05; Mann-Whitney U test). Overlapping ranges of values were measured for the C(L)P and control groups. The least mobility (4.75 cm3) was measured in patients who had undergone pharyngeal flap surgery. Different patterns of restriction were observed in patients with and without a pharyngeal flap. Acoustic pharyngometry may provide access to noninvasive quantitative measurement of velopharyngeal movement and a better understanding of the pattern of movement in C(L)P-patients. We expect it to be a helpful tool in objectively monitoring the progress of logopedic therapy.

Measurement of velopharyngeal movements induced by isolated stimulation of levator veli palatini and pharyngeal constrictor muscles.

The levator veli palatini (LVP) and superior pharyngeal constrictor muscles (PC) close the velopharynx. However, for the velopharyngeal movements to be understood in detail, each muscle contraction must be analyzed precisely. This study was performed to clarify the velopharyngeal movement which was induced by a single muscle contraction, LVP or PC. Using a nasopharyngeal fiberscope, we analyzed the velopharyngeal movement associated with the contraction of the LVP and PC muscles in mongrel dogs. To elicit the maximal contraction of each muscle, we applied repetitive electrical stimulation to each peripheral nerve efferent to the LVP or PC muscle. Stimulation with a frequency of 77 Hz and 83 Hz induced maximal tension in the LVP and PC muscles, respectively, in isometric contraction. In a second series of experiments, fiberscopic views of the velopharyngeal movements associated with each muscle's maximal contraction were recorded. The degree of closure was calculated at several sections. The LVP muscle pulled the caudal fourth of the soft palate, while the PC projected the posterior wall at the level of the caudal end of the soft palate. The PC muscle also projected the lateral wall of the velopharynx. The effect of LVP contraction on the lateral wall was very small. These results show that the velopharyngeal movement associated with LVP contraction is very different from that with PC contraction.

Activities of superior pharyngeal constrictor and levator veli palatini muscles related to respiration in dogs.

This study, using mongrel dogs, attempted to delineate the respiratory activity of two closure muscles of the velopharynx, the levator veli palatini (LVP) and superior pharyngeal constrictor (PC) muscles. Fifteen mongrel dogs were given tracheotomies, with intratracheal tubes being connected to their respiratory circuits. Activities of the PC and LVP muscles were recorded electromyographically, and the effects of PaO2 and PaCO2 were analyzed along with the effects of lung inflation intratracheally with O2 and N2. Under hypoxic conditions, expiratory LVP activity was observed while PC activity diminished. The effects of lung inflation on both LVP and PC activities were also studied. The activities of both muscles were enhanced by lung inflation. It was thus suggested that the roles of both muscles during velopharyngeal closing movements are not the same.