DOCSLIB.ORG

Incongruous Movements of the Velum and Lateral Pharyngeal Walls

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Incongruous Movements of the Velum and Lateral Pharyngeal Walls Incongruous Movements of the Velum and Lateral Pharyngeal Walls ROBERT J. SHPRINTZEN, Ph.D. SAUL J. RAKOFF, M.D. M. LEON SKOLNICK, M.D. ALFRED S. LAVORATO, Ph.D. Bronx, New York 10467 Five patients evaluated via multi-view videofluoroscopy were found to have incongruous movements between the velum and lateral aspects of the pharyngeal walls. All five patients had velopharyngeal insufficiency resulting from either absent lateral pharyngeal wall motion in the presence of velar mobility or absent velar mobility in the presence of lateral pharyngeal wall motion. The data indicates that these valving patterns are not rare phenomena of velopharyngeal valving. Treatment by pharyn- geal flap or other methods for velopharyngeal insufficiency must be suited to these peculiar valving patterns based on adequate diagnostic information. The physiology of velopharyngeal closure has been debated and questioned on numerous occasions and as is indicated by Dickson, et al. (1974): "Opinions regarding the specific muscles responsible for these patterns of movement are almost as numerous as authors who discuss them (p. 477)." A multiplicity of explanations have been offered in discussing the posterosuperior movement of the velum and medial movements of the lateral pharyngeal walls during speech. There is general agreement that the levator muscle is responsible for observed velar mobility (Dickson, et al., 1974), but the muscles contributing to movements of the pharyngeal walls remain a point of contention. The purpose of this paper is to present some case reports of subjects who showed unusual patterns of velopharyngeal valving which raise questions concerning the physiology of velopharyngeal closure and methods for treating velopharyngeal insufficiency. It must be empha- sized that the multi-view videofluoroscopic data presented below do not answer any existing questions but may aid in constructing further hy- potheses for future investigations. It has been well established that medial motion of the lateral pharyn- geal walls is essential to velopharyngeal closure (Calnan, 1953; Harring- Robert J. Shprintzen, Ph.D., is Co-ordinator and Deputy Director of the Center for Craniofacial Disorders at Montefiore Hospital and Medical Center, Bronx, N.Y., Adjunct Associate Professor of Speech Pathology at C. W. Post Center of Long Island University and at Kean College of New Jersey. Alfred S. Lavorato, Ph.D., is Supervisor of the Division of Speech Pathology in the Department of Audiology, Eye and Ear Hospital of Pittsburgh, and Research Associate at the University of Pittsburgh Cleft Palate Center. Saul J. Rakoff, M.D., is Associate Attending, Department of Radiology at Montefiore Hospital and Medical Center and Associate Professor of Radiology at the Albert Einstein College of Medicine. M. Leon Skolnick, M.D., is Associate Professor of Radiology at the University of Pittsburgh School of Medicine. 148 Shprintzen et al., inconcruvous movements 149 ton, 1945; Skolnick, 1969; Takahasi, 1962). Medial motion of the pharyn- geal walls has been variously attributed to the salpingopharyngeus, levator, and superior constrictor muscles. While the salpingopharyn- geus has been described as a contributor to lateral pharyngeal wall movement (Bloomer, 1953; Harrington, 1944; Zemlin, 1968), more re- cent findings tend to indicate that the salpingopharyngeus is only incon- sistently present in man and typically not well defined nor large enough to account for such motion (Dickson and Dickson, 1972; Dickson, et al., 1974; McMyn, 1940; Strong, 1949). It has been hypothesized that the levator is the sole muscle of velopharyngeal closure, producing both velar and pharyngeal wall motion components (Dickson, 1972; Dickson and Dickson, 1972). Other reported data from multi-view fluoroscopic analyses (Shprintzen, et al., 1974; Shprintzen, et al., 1975b), electro- myography (Fritzell, 1969), and ultra-sonic studies (Ewanowski, et al., 1974; Zagzebski, 1975) would seem to indicate that there is a separate muscular component involved in lateral pharyngeal wall movement, most likely the superior constrictor. The present study was designed to evaluate the relationship between palatal and pharyngeal wall movements. Method |_ _- - SuBjEctTs. The subjects selected were five patients evaluated at the Center for Craniofacial Disorders of Montefiore Hospital and Medical Center. Each patient exhibited velopharyngeal incompetence (not nec- essarily cleft palate) and was chosen because he demonstrated what was considered to be an atypical pattern of velopharyngeal valving. The subjects included: (A) a four-year-old female, (B) a five-year-old male, (C) a five-year-old female, (D) a thirty-one-year-old male, and (E) a thirty-three-year-old male. ExPERIMENTAL PrRocEDURE. The VldCOflUOI‘OSCOplC procedure uti- lized to examine the subjects has been reported in detail elsewhere (Shprintzen, et al., 1975b; Skolnick, 1969). All subjects were examined in lateral, frontal, base, and left and right oblique projections. The subjects repeated a series of speech tasks designed to elicit speech in varying phonemic contexts and engaged in non-speech activities as well. The tasks used were: , ma-ma-ma-ma-ma ’ Kitty-cat pa-pa-pa-pa-pa Give Kate the cake ta-ta-ta-ta-ta Gerry's slippers ka-ka-ka-ka-ka Stop the bus ssssss (sustained /s/ phoneme) Catch a fish Suzie | One, two,. .. ., ten (counting to ten) Suzie sees Sally Blowing Popeye ' Whistling Popeye plays baseball Swallowing The total time under fluoroscopy was typically between two and three minutes with less than two rads irradiation. Resulting video images were recorded on a one-inch video tape recorder (Sony EV 210) and were 150 Cleft Palate Journal, April 1977, Vol. 14 No. 2 reviewed in full speed, slow motion, and stopped frames (60 visual fields per second) from a 14-inch TV monitor (Conrac) w1th a line scan rate of 945. Results SumBjEct A. Subject A was referred to the center at the age of four years, eight months, because of poor speech development secondary to a complete bilateral cleft lip and palate. She had had a one-stage lip repair at one month of age and a repair of the soft palate at 18 months of age at another institution. She had an unrepaired cleft of the hard palate which had never been obturated prosthetically. Her speech was charac- terized by severe hypernasal resonance, audible nasal air flow, and numerous articulatory omissions, distortions, and substitions. Much of her articulation was characterized by glottal stops. Language, however, was age appropriate. Multi-view videofluoroscopic examination showed fair mobility of the velum as observed in lateral view. However, no contact was made between the velum and either the posterior pharyn- geal wall or a small adenoid mass in the nasopharynx. No movement was observed in the posterior pharyngeal wall. The velum formed a velar eminence during speech, but a consistent two mm gap was observed between the velum and adenoid mass. Frontal view showed no observa- ble medial movement in the lateral pharyngeal walls. Base and left and right oblique views confirmed that the velum was moving but that the lateral pharyngeal walls were not (Figure 1). SumBpEct B. This five-year-old male subject was referred to the center at the age of four years, one month, because of a life-long history of hypernasal resonance and poor articulation in the absence of an overt or submucous cleft palate. Speech was severely hypernasal and articulation was characterized by numerous articulatory omissions, substitutions, REST / AND SPEECH LATERAL VIEW FRONTAL VIEW FIGURE 1. Videofluoroscopic tracings for Subject A showing velar motion in lateral view during speech but absence of lateral wall motion in frontal view. Shprintzen et al., INCONGRUOUS MOVEMENTS 151 and distortions, and glottal stops. Language skills were slightly de- pressed. Significant factors in his history included congenital hypothy- roidism and possible neurological impairment. (Neurological examina- tion was within normal limits, but psychometric evaluation revealed some specific learning disabilities.) Both gross and fine motor coordina- tion were within normal limits. Videofluoroscopic examination revealed that the velum was within normal limits in thickness and length, but there was no velar motion observed during speech in lateral view. No motion was observed in the posterior pharyngeal wall in lateral view , but in frontal view, excellent movement was observed in the lateral aspects of the pharyngeal walls as described by Shprintzen et al., (1975b) with a sharp shelf-like pattern at the level of the hard palate (Flgure 2). C. This five-year-old female child was referred to the center at the age of four years, ten months, by a neurologist because of a life- long history of hypernasal resonance in the absence of an overt or submucous cleft palate. Her speech was characterized by severe hyper- nasal resonance and numerous articulatory distortions and substitu- tions. Language skills were significantly disordered but had improved over the previous year. History was remarkable in that, at birth; follow- ing a full-term pregnancy, there was no sucking reflex until five days of age. All developmental landmarks were somewhat delayed, but by the age of four, she had no apparent deficits. All neurological examinations were negative and intelligence was within normal limits. Multi-view videofluoroscopic examination revealed a palate and nasopharynx of normal proportions. Lateral view showed some limited velar mobility in a posterosuperior direction. Velar contact was not made with a moder- ate sized adenoid mass nor with the posterior pharyngeal wall. In frontal Rest AMD [ SPEECH f est [| l SPEECH l | | | | | | . \ LATEML VIE FRONTAL VIEW FIGURE 2. Vldeofluoroscoplc tracings for Subject B showmg absence of velar motlon during speech in lateral view but good lateral wall movement in frontal view. 152 Cleft Palate Journal, April 1977, Vol. 14 No. 2 view, there was no demonstrable lateral pharyngeal wall motion, an observation which was confirmed in base and oblique views (Figure 3). - SuBpECT D. This thirty-one-year-old male was referred to the center at the age of thirty years, nine months, by a prosthodontist.
Load more

Recommended publications
  • UC Berkeley Dissertations, Department of Linguistics
    UC Berkeley Dissertations, Department of Linguistics Title The Aeroacoustics of Nasalized Fricatives Permalink https://escholarship.org/uc/item/00h9g9gg Author Shosted, Ryan K Publication Date 2006 eScholarship.org Powered by the California Digital Library University of California The Aeroacoustics of Nasalized Fricatives by Ryan Keith Shosted B.A. (Brigham Young University) 2000 M.A. (University of California, Berkeley) 2003 A dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Philosophy in Linguistics in the GRADUATE DIVISION of the UNIVERSITY OF CALIFORNIA, BERKELEY Committee in charge: John J. Ohala, Chair Keith Johnson Milton M. Azevedo Fall 2006 The dissertation of Ryan Keith Shosted is approved: Chair Date Date Date University of California, Berkeley Fall 2006 The Aeroacoustics of Nasalized Fricatives Copyright 2006 by Ryan Keith Shosted 1 Abstract The Aeroacoustics of Nasalized Fricatives by Ryan Keith Shosted Doctor of Philosophy in Linguistics University of California, Berkeley John J. Ohala, Chair Understanding the relationship of aerodynamic laws to the unique geometry of the hu- man vocal tract allows us to make phonological and typological predictions about speech sounds typified by particular aerodynamic regimes. For example, some have argued that the realization of nasalized fricatives is improbable because fricatives and nasals have an- tagonistic aerodynamic specifications. Fricatives require high pressure behind the suprala- ryngeal constriction as a precondition for high particle velocity. Nasalization, on the other hand, vents back pressure by allowing air to escape through the velopharyngeal orifice. This implies that an open velopharyngeal port will reduce oral particle velocity, thereby potentially extinguishing frication. By using a mechanical model of the vocal tract and spoken fricatives that have undergone coarticulatory nasalization, it is shown that nasal- ization must alter the spectral characteristics of fricatives, e.g.
    [Show full text]
  • Velopharyngeal Insufficiency in Children
    Open Access Austin Journal of Otolaryngology A Austin Full Text Article Publishing Group Review Article Velopharyngeal Insufficiency in Children Abdel-Aziz M* Department of Otolaryngology, Cairo University, Egypt Abstract *Corresponding author: Mosaad Abdel-Aziz, Velopharyngeal insufficiency (VPI) is the incomplete closure of the Department of Otolaryngology, Cairo University, 2 el- velopharyngeal valve during articulation and may be during feeding. The patients salam st., King Faisal, Above El-baraka bank, Giza, Cairo, presented with hypernasal speech which results in difficult communication with Egypt its negative effects on the social life of the family. The problem has many causes Received: August 21, 2014; Accepted: September 07, that include structural defects either in palatal or in pharyngeal muscles. For 2014; Published: October 10, 2014 better understanding of the underlying cause, good anatomical knowledge should be acquainted. Assessment of patients includes otolaryngologic examination, auditory perceptual assessment, nasometric assessment, and radiologic evaluation. However, flexible nasopharyngoscopy is very important to detect the degree and type of velopharyngeal closure pattern. The condition should be managed through a team approach that includes an otolaryngologist, a speech and language pathologist, an audiologist, a radiologist, an orthodontist, a pediatrician, and a psychologist. Speech therapy can be used for patients with small velopharyngeal gap and in postoperative patients where functional residual VPI is present. Orthodontic treatment with palatal obturator or speech aid prostheses is used for children with VPI who are not surgical candidates for palatal reconstruction, or who have had less than optimal surgical results. Surgical intervention is indicated for patients with structural defects, it is either palatal or pharyngeal procedure that aiming for strengthening and/or narrowing of the velopharyngeal valve.
    [Show full text]
  • Cleft Palate/Lip
    CLEFT PALATE/LIP WHAT IS A CLEFT? A cleft is a separation in the skin, tissue lining of the mouth, muscle, and bone that is normally fused together; however, no structures are missing. Clefts can be either unilateral (one side) or bilateral (both sides) and may include the lip, soft palate and/or hard palate or any of the structures in isolation. TYPES OF CLEFTS Cleft Lip – separation in the lip and may include the bottom of the nose Cleft Palate – separation in the hard palate and/or soft palate Submucous Cleft – separation in the muscle of the soft palate with the tissue lining of the mouth intact. Often, it is not easily viewed. WHEN DID CLEFTING HAPPEN? During the 4th week of fetal development, the primary palate (line from nostril to upper lip and mucosa behind upper teeth) fuse together. By the 8th week, the tongue drops in the mouth and the secondary palate (hard palate and soft palate) fuse together with the nasal septum. By the 12th week, if the process is not complete, a cleft (separation) will develop. WHAT CAUSED MY CHILD’S CLEFT? The exact cause is not known but theories include: Low intake of Folic Acid (Vitamin B) Large intake of Vitamin A Genetic disposition Syndromes or Sequences (Pierre Robin, Treacher Collins) Drugs, alcohol, medication, and smoking CLEFT PALATE MANAGEMENT You and your child will be in contact with many different healthcare professionals who need to work together. Every case is individualized, therefore your child will need a thorough assessment to the appropriate treatment plan.
    [Show full text]
  • Section V. Resonance and Phonation SAMUEL G. FLETCHER, Ph.D. (CHAIRMAN) Despite an Ever Widening Scope of Topics in Cleft Palate
    Section V. Resonance and Phonation SAMUEL G. FLETCHER, Ph.D. (CHAIRMAN) Despite an ever widening scope of topics use of instrumentation and procedures to in cleft palate research, progress in reha- increase diagnostic and management pre- bilitation is still largely defined by the ex- cision, and (c) systematic evaluation of tent to which speech disorders exist, may «speech treatment restults. The importance be prevented, or are eradicated (Bauer, of multistructural dynamic impairment 1972; Randal, 1974; Kraus, VanDemark, - has also been mentioned frequently but and Tharp, 1975; Wilder and Baken, has received little direct attention. 1975). In the speech section of the previous Palatopharyngeal Disturbance Without state-of-the-art review (Spriestersbach et Overt Cleft al., 1973) major attention was given to Identification of palatopharyngeal dis- three broad aspects of speech research: 1) turbance in the absence of overt cleft disturbances in anatomical and physiologi- serves to highlight a variety of disorders cal aspects of speaking; 2) assessment of with potentially common speech symptom- special speech characteristics and disor- atology. Calnan (1976) recently re-pre- ders attributable to maxillofacial anomaly; sented his system for classifying such dis- and 3) therapeutic processes and proce- turbances. Minami and associates (1975) dures for speech habilitation. A number of proposed an expanded etiological classifi- issues identified in the earlier review re- cation system in which nearly fifty types of main unresolved. For example, informa- disability known to affect palatopharyn- tion is still unavailable concerning a variety geal structure and function are itemized. of essential components of velopharyngeal They also reviewed observations from 188 (V-P) movement in speakers with V-P in- patients and attempted to differentiate eti- sufficiency.
    [Show full text]
  • Treatment Options for Better Speech
    TREATMENT OPTIONS FOR BETTER SPEECH TREATMENT OPTIONS FOR BETTER SPEECH Major Contributor to the First Edition: David Jones, PhD, Speech-Language Pathology Edited by the 2004 Publications Committee: Cassandra Aspinall, MSW, Social Work John W. Canady, MD, Plastic & Reconstructive Surgery David Jones, PhD, Speech-Language Pathology Alice Kahn, PhD, Speech-Language Pathology Kathleen Kapp-Simon, PhD, Psychology Karlind Moller, PhD, Speech-Language Pathology Gary Neiman, PhD, Speech-Language Pathology Francis Papay, MD, Plastic Surgery David Reisberg, DDS, Prosthodontics Maureen Cassidy Riski, AuD, Audiology Carol Ritter, RN, BSN, Nursing Marlene Salas-Provance, PhD, Speech-Language Pathology James Sidman, MD, Otolaryngology Timothy Turvey, DDS, Oral/Maxillofacial Surgery Craig Vander Kolk, MD, Plastic Surgery Leslie Will, DMD, Orthodontics Lisa Young, MS, CCC-SLP, Speech-Language Pathology Figures 1, 2 and 5 are reproduced with the kind permission of University of Minnesota Press, Minneapolis, A Parent’s Guide to Cleft Lip and Palate, Karlind Moller, Clark Starr and Sylvia Johnson, eds., 1990. Figure 3 is reproduced with the kind permission of Millard DR: Cleft Craft: The Evolution of its Surgeries. Volume 3: Alveolar and Palatal Deformities. Boston: Little, Brown, 1980, pp. 653-654 Figure 4 is an original drawing by David Low, MD. Copyright ©?2004 by American Cleft Palate-Craniofacial Association. All rights reserved. This publi-cation is protected by Copyright. Permission should be obtained from the American Cleft Palate-Craniofacial Association
    [Show full text]
  • Speech Results and Associated Findings Following Pharyngeal Flap Surgery in an Established State Craniofacial Disorders Program
    University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 1985 Speech results and associated findings following pharyngeal flap surgery in an established state craniofacial disorders program Maureen Patricia McMahon The University of Montana Follow this and additional works at: https://scholarworks.umt.edu/etd Let us know how access to this document benefits ou.y Recommended Citation McMahon, Maureen Patricia, "Speech results and associated findings following pharyngeal flap surgery in an established state craniofacial disorders program" (1985). Graduate Student Theses, Dissertations, & Professional Papers. 3639. https://scholarworks.umt.edu/etd/3639 This Professional Paper is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. COPYRIGHT ACT OF 1976 THIS IS AN UNPUBLISHED MANUSCRIPT IN WHICH COPYRIGHT SUB­ SISTS. ANY FURTHER REPRINTING OF ITS CONTENTS MUST BE APPROVED BY THE AUTHOR. MANSFIELD LIBRARY UNIVERSITY OF MONTANA DATE : 19 8 5 Speech Results and Associated Findings Following Pharyngeal Flap Surgery in an Established State Craniofacial Disorders Program by Maureen Patricia McMahon B.A., Carroll College, 1982 Presented in Partial Fulfillment of the Requirements for the Degree of Master of Communication Sciences and Disorders UNIVERSITY OF MONTANA 1985 Approved by: ^ Chairman, fioard ot''examiners Dean, Graduate School / Date UMI Number: EP34664 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted.
    [Show full text]
  • Robust Estimation of Hypernasality in Dysarthria with Acoustic Model
    1 Robust Estimation of Hypernasality in Dysarthria with Acoustic Model Likelihood Features Michael Saxon1, Ayush Tripathi2, Yishan Jiao3, Julie Liss3, and Visar Berisha1;3 1School of Electrical, Computer, and Energy Engineering, Arizona State University 2Department of Electrical and Electronics Engineering, Visvesvaraya National Institute of Technology 3College of Health Solutions, Arizona State University Abstract—Hypernasality is a common characteristic symp- work we present automated metrics for hypernasality scoring tom across many motor-speech disorders. For voiced sounds, that are robust to disease- and speaker-specific confounders. hypernasality introduces an additional resonance in the lower Clinician perceptual assessment is the gold-standard tech- frequencies and, for unvoiced sounds, there is reduced articu- latory precision due to air escaping through the nasal cavity. nique for assessing hypernasality [8]. However, this method However, the acoustic manifestation of these symptoms is highly has been shown to be susceptible to a wide variety of er- variable, making hypernasality estimation very challenging, both ror sources, including stimulus type, phonetic context, vocal for human specialists and automated systems. Previous work in quality, articulation patterns, and previous listener experience this area relies on either engineered features based on statistical [9]. Additionally, these perceptual metrics have been shown signal processing or machine learning models trained on clinical ratings. Engineered features often fail to capture the complex to erroneously overestimate severity on high vowels when acoustic patterns associated with hypernasality, whereas metrics compared with low vowels [10], and vary based on broader based on machine learning are prone to overfitting to the phonetic context [11]. Although these difficulties may be small disease-specific speech datasets on which they are trained.
    [Show full text]
  • Velopharyngeal Sphincter Pathophysiologic Aspects in the in Cleft Palate
    Artigo de Revisão Velopharyngeal Sphincter Pathophysiologic Aspects in the in Cleft Palate Daniela Preto da Silva*, Sílvia Dornelles**, Lauren Medeiros Paniagua***, Sady Selaimen da Costa****, Marcus Vinicius Martins Collares*****. * Otorhinolaryngologist medical doctor. In course for Master’s Degree in the Program for Post-Graduation in Medicine: Surgery of Universidade Federal do Rio Grande do Sul. ** Phonoaudiologist. In Course for Doctor’s Degree of Post-Graduation in Medical Sciences: Paediatrics of Universidade Federal do Rio Grande do Sul. ** Phonoaudiologist. In Course for Master’s Degree of Post-Graduation in Medical Sciences: Paediatrics of Universidade Federal do Rio Grande do Sul. **** Otorhinolaryngologist Medical Doctor. Associate Professor of Otorhinolaryngology Discipline of the Medicine College of Universidade Federal do Rio Grande do Sul. ***** Doctor, Plastic Surgeon. Assistant Professor of Plastic Surgery Discipline of the Medicine College of Universidade Federal do Rio Grande do Sul. Head of the Craniomaxillofacial Surgery Service of Hospital de Clínicas de Porto Alegre. Institution: Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Services of Otorhinolaryngology and Craniomaxillofacial Surgery, Otorhinolaryngology and Cleft Palate Ambulatory Porto Alegre / RS - Brazil. Mail address: Daniela Preto da Silva - Avenida Soledade, 569 - Conj. 805 e 806 - Torre Beta - Porto Alegre / RS - Brazil - Zip code: 90470-340 - Phone: (+55 51) 3378- 9997 - E-mail: [email protected] Article received on December 04, 2007. Article approved on August 23, 2008. SUMMARY Introduction: Cleft lip and palate are common congenital abnormalities with typical functional disorders on speech, deglutition and middle ear function. Objective: This article reviews functional labiopalatine disorders through a pathophysiological view. Method: We performed a literature search on line, as well as books and periodicals related to velopharyngeal sphincter.
    [Show full text]
  • Evaluation of Nasal Speech a Study of Assessments by Speech-Language Pathologists, Untrained Listeners and Nasometry
    UMEÅ UNIVERSITY MEDICAL DISSERTATION New series No 1185, ISBN 978-91-7264-678-0, ISSN 0346-6612-1222 Department of Clinical Sciences, Speech and Language Pathology, Umeå University SE-901 87 Umeå, Sweden Evaluation of nasal speech A study of assessments by speech-language pathologists, untrained listeners and nasometry Karin Brunnegård Umeå 2008 Copyright © 2008 Karin Brunnegård Dept of Clinical Sciences, Speech and Language Pathology Umeå University SE-901 87 Sweden Photo on cover: Carina Kristiansson Printed by Print & Media, Umeå, Sweden - 2 - TABLE of CONTENTS ABSTRACT -5- POPULÄRVETENSKAPLIG SAMMANFATTNING -7- LIST of ARTICLES -9- WORD LIST/ORDLISTA (English – Swedish) -10- PREFACE -11- INTRODUCTION -12- BACKGROUND -12- Normal speech production Resonance disorders and velopharyngeal impairment Resonance disorders in cleft lip and palate Resonance disorders in other groups Auditory perceptual assessments Perceptual assessment of cleft lip and palate and VPI Reliability of perceptual assessment of nasality Validity of perceptual assessments of nasality Untrained listeners in speech assessments Instrumental assessment The Nasometer™ - an acoustic instrument AIMS -21- METHODS -22- Participants Speakers Listeners Assessment materials and instrumentation Speech stimuli Audio-recordings of perceptual speech stimuli Assessment form for expert and non-expert SLPs Assessment form for untrained listeners Experimental procedures Auditory perceptual assessment Measurement of nasalance Data analysis Reliability of auditory perceptual ratings for
    [Show full text]
  • Original Article Original Article Pediatric/Craniofacial Xxx Congenital Palatal Fistula Associated with Xxx Submucous Cleft Palate
    Mahalakshmi ORIGINAL ARTICLE Original Article Pediatric/Craniofacial xxx Congenital Palatal Fistula Associated with xxx Submucous Cleft Palate 2016 Mekonen Eshete, MD* Liliana Camison, MD† Background: Although cleft lip and cleft palate are among the most com- mon congenital malformations, the presence of an isolated congenital Plastic & Reconstructive Surgery-Global Open Fikre Abate, MD‡ Taye Hailu, MD‡ palatal fistula along with a submucous cleft is very rare. This appears as Yohannes Demissie, MD* an oval-shaped, full-thickness fenestration in the palatal midline that does 4 Ibrahim Mohammed, MD* not fully extend anteriorly or posteriorly, accompanied by the findings of a Azeez Butali, DDS, PhD§ submucous cleft. Because of the uncommon nature of this entity, there is H. Wolfgang Losken, MD¶ controversy about its etiology, diagnosis, and management. 2 Alexander M. Spiess, MD† Methods: Two cases of children with congenital palatal fistulae and a sub- mucous cleft palate are presented who were treated in different settings by different surgeons. Cases are discussed along with a thorough review of the Congenital Palate Fistula available literature. Results: Patient 1 presented at 4 years of age with “a hole in the palate” Eshete et al. since birth and abnormal speech. His palatal fistula and submucous cleft were repaired with a modified von Langenbeck technique in Ethiopia. At a 2-year follow-up, the palate remained closed, but hypernasal speech per- sisted. Patient 2 was a 1-year-old presenting with failure to thrive and nasal regurgitation, who underwent a Furlow palatoplasty in the United States with good immediate results. She was unfortunately lost to follow-up.
    [Show full text]
  • Adenotonsillectomy Complications
    ADENOTONSILLECTOMY COMPLICATIONS ELENA RIZZO RIERA R1 ORL HUSE PALATINE TONSILS • Component of Waldeyer’s tonsillar ring. Consists of • Lingual tonsil • Palatine tonsils (2) • Adenoids (NF tonsil) • Lymphoid tissue on the posterior pharyngeal wall PALATINE TONSILS • The PT are the largest component of the ring. • Defense against infection. Development of the immune system. • PT grow throughout childhood until the age of 11 years. • Decrease spontaneously. • Placed in the space between the palatopharyngeal and palatoglossus muscles. • Hyperplasia of the tonsilsà breathing and swallowing problems. PALATINE TONSILS SPECIALIZED HISTOLOGIC STRUCTURE: • Matrix: lymphoid tissue with crypts. • Cells organized in lymphoid follicles. • Adherent to a capsuleà limited inflammation. • Stratified squamous epithelium. ADENOIDS • Median mass of mucosa situated in the posterior wall of nasopharinx. • Composed of vertical ridges of lymphoid tissue separated by deep clefts. • Pseudostratified ciliated columnar epithelium. ADENOIDS • Prominent in children up to 6 years of age. • Gradually undergo atrophy. • Hyperplasia of the adenoids: § Nasal obstruction § Epistaxis § Voice change § Tubal obstruction § Otitis media TONSILS AND ADENOIDS BLOOD SUPPLY • Tonsillar branch of the facial artery is the main supply of the entire tonsil. • Facial artery: • Tonsillar art • Ascending palatine art • Lingual art • dorsal lingual branch • Internal maxillary art • Desceding palatine • Greater palatine • Ascending pharyngeal (ECA) • Adenoids: • Ascending palatine, • Ascending
    [Show full text]
  • Submucous Cleft Palate and the General Practitioner R
    MEDICAL PRACTICE Submucous cleft palate and the general practitioner R. B. Lowry, m.b., b.ch., f.r.c.p.[c], A. D. Courtemanche, m.d., f.r.c.s.[c] and C. MacDonald, m.a., Vancouver, B.C. Summary: Submucous cleft palate latente, la lesion peut etre revelee is a permanent feature after this opera¬ refers to a situation where the soft par une adenoidectomie: en effet les tion. Such patients probably have a palate is largely composed of mucosa vegetations adenoides ont jusque la submucous cleft palate. Their soft with little or no muscle. The defect constitue un facteur compensatoire palate contains little or no muscle, is often not obvious on inspection of permettant la fermeture palatopha- being composed almost exclusively of the mouth and pharynx. There is ryngienne. II importe done que les mucosa, and therefore is unable to considerable clinical variation, with medecins qui pratiquent I'amygdalec- effect palatopharyngeal closure. Fig. 1 speech ranging from normal or minimal tomie et I'adenoidectomie connaissent summarizes the signs and symptoms nasality to severe nasality and defective bien les signes et symptdmes qui which should lead a physician to sus- articulation. Many patients who have peuvent mener au diagnostic. pect this disorder. Bifid uvula is a latent submucous cleft palate have frequent but not an invariable finding, the condition unmasked by an Many physicians are familiar with the and a variety of other palatal morpho- adenoidectomy because the adenoid fact that occasional patients may have logic variations may be seen.1 pad had served as a compensatory hypernasal speech following a tonsillec¬ factor in effecting palatopharyngeal tomy and adenoidectomy.
    [Show full text]