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Velopharyngeal incompetence in patients with cleft palate, flexible video pharyngoscopy and perceptual speech assessment: a correlational pilot study

Published online by Cambridge University Press:  22 October 2014

S Rajan ,
M Kurien ,
A K Gupta ,
S S Mathews ,
R R Albert  and
D Tychicus
S Rajan*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
M Kurien
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
A K Gupta
Affiliation:
Department of Plastic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
S S Mathews
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
R R Albert
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
D Tychicus
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
*
Address for correspondence: Dr S Rajan, Department of Otorhinolaryngology and Head Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, IndiaPIN-632004 Fax: +416-2232035 E-mail: [email protected]
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Abstract

Objectives:

To assess the role of video endoscopy in evaluating velopharyngeal incompetence and investigate a possible relationship between velopharyngeal incompetence type and speech defect in cleft palate patients.

Methods:

A prospective study of 28 pre- or post-operative cleft palate patients with speech defects who attended Plastic Surgery–Cleft Palate and ENT out-patient clinics was performed. The velar defect type was determined using a flexible endoscope and findings were video recorded. Speech pathology was assessed using the cleft palate audit protocol for speech.

Results:

A significant, clinically relevant relationship was noted between the perceived characteristics of hypernasality and velopharyngeal insufficiency type. Hypernasal speech was a definite clinical indicator of velopharyngeal incompetence, and the type 1 velopharyngeal defect was most common. Type 1 velopharyngeal coronal-type dysfunction was strongly associated with hypernasality (p < 0.05). When speech substitution was noted, type 2 velopharyngeal (or sagittal) incompetence could be predicted (p < 0.05).

Conclusion:

In the management of cleft palate patients, it is important that surgical correction of the defect and achieving velopharyngeal competency for speech are performed simultaneously. Pre-operative velopharyngeal endoscopy with speech assessment will define the anatomical and functional bases for velopharyngeal correction and assist in planning and tailoring the pharyngeal flap.

Keywords

Velopharyngeal InsufficiencyCleft PalateVideo RecordingSpeechDiagnostic Techniques and Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 11 , November 2014 , pp. 986 - 990
Copyright
Copyright © JLO (1984) Limited 2014 

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References

1Shprintzen, RJ, Golding, KJ. Evaluation of velopharyngeal insufficiency. Otolaryngol Clin North Am 1989;22:519–36Google Scholar
2Shprintzen, RJ, Marrinan, E. Velopharyngeal insufficiency: diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2009;17:302–7CrossRefGoogle ScholarPubMed
3Ysunza, A, Landeros, L, Pamplona, MC, Prado, H, Arrieta, J, Fajardo, G. The role of laryngeal electromyography in the diagnosis of vocal fold immobility in children. Int J Pediatr Otorhinolaryngol 2007;71:949–58Google Scholar
4Loney, RW, Bloem, TJ. Velopharyngeal dysfunction: recommendations for use of nomenclature. Cleft Palate J 1987;24:334–5Google Scholar
5Barr, L, Thibeault, SL, Muntz, H, de Serres, L. Quality of life in children with velopharyngeal insufficiency. Arch Otolaryngol Head Neck Surg 2007;133:224–9CrossRefGoogle ScholarPubMed
6Shah, CP, Wong, D. Management of children with cleft lip and palate. Can Med Assoc J 1980;122:19–24Google ScholarPubMed
7Tweedie, DJ, Skilbeck, CJ, Wyatt, ME, Cochrane, LA. Partial adenoidectomy by suction diathermy in children with cleft palate, to avoid velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol 2009;73:1594–7Google Scholar
8Marsh, JL. Velo-pharyngeal dysfunction: Evaluation and management. Indian J Plast Surg 2009;42(Suppl):S129–36CrossRefGoogle ScholarPubMed
9Ozgur, F, Tuncbilek, G, Cila, A. Evaluation of velopharyngeal insufficiency with magnetic resonance imaging and nasoendoscopy. Ann Plast Surg 2000;44:8–13Google Scholar
10Ysunza, A, Pamplona, M, Femat, T, Mayer, I, Garcia, VM. Videonasopharyngoscopy as an instrument for visual biofeedback during speech in cleft palate patients. Int J Pediatr Otorhinolaryngol 1997;18;41:291–8Google Scholar
11Rowe, MR, D'Antonio, LL. Velopharyngeal dysfunction: evolving developments in evaluation. Curr Opin Otolaryngol Head Neck Surg 2005;3:366–70Google Scholar
12Karen, J, Golding, K. Standardization for the reporting of nasopharyngoscopy and multiview videofluroscopy: A report from an International Working Group. Cleft Palate J 1990;27:337–47Google Scholar
13D'Antonio, LL, Muntz, HR, Marsh, JL, Marty-Grames, L, Backensto-Marsh, R. Practical application of flexible fiberoptic nasopharyngoscopy for evaluating velopharyngeal function. Plast Reconstr Surg 1998;82:611–8Google Scholar
14Muntz, H, Taylor, H, Smith, ME. Velopharyngeal dysfunction. In: Cummings, CW, Flint, PW, Harker, LA, Haughey, BH, Richardson, MA, Robbins, MA, Schuller, DE, Thomas, JR, eds. Cummings Otolaryngology: Head and Neck Surgery, 4th edn.Philadelphia: Elsevier Mosby 2005;177:4086–98.Google Scholar