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The Pharynx and Oral Cavity
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
The adenoids are rudimentary at birth but enlarge to occupy a substantial part of the nasopharynx between the ages of about 2 and 7 years. Adenoids can obstruct the nasopharyngeal airway and the orifices of the Eustachian tube, contributing respectively to OSA and OME. There has been increasing focus in recent years on the role of the adenoids as a reservoir of chronic infection. ‘Biofilms’ are aggregates of bacteria in a complex mucopolysaccharide matrix which is resistant to conventional antimicrobial therapy and may contribute to recurrent infections in the nose, sinuses and middle ear. Adenoidectomy – often in association with an intervention such as tonsillectomy (typically for OSA) or insertion of grommets – is a common ORL procedure in children. Indications include OSA, OME and persistent rhinitis that has been resistant to medical therapy. Blind curettage with a sharp blade has been the traditional technique, but ORL specialists are increasingly moving towards surgery under direct vision (coblation and suction diathermy) using an endoscope and a screen/monitor, permitting much more accurate and thorough removal of tissue. The main complication of adenoidectomy is bleeding. Velopharyngeal insufficiency, characterised by escape of air from the nasal cavity during phonation (rhinolalia aperta), is often noted in the weeks and months following surgery but is usually temporary. Persistent cases can be troublesome and, very occasionally, warrant corrective pharyngeal or palatal surgery.
Cleft Lip, Cleft Palate, and Velopharyngeal Insufficiency
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
This article provides an introduction to the anatomical and clinical features of the primary deformities associated with unilateral cleft lip–cleft palate, bilateral cleft lip–cleft palate, and cleft palate. The diagnosis and management of secondary velopharyngeal insufficiency (VPI) are discussed. The accompanying videos demonstrate the features of the cleft lip nasal deformities and reliable surgical techniques for unilateral cleft lip repair, bilateral cleft lip repair, and radical intravelar veloplasty (IVVP).
Oropharynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
The soft palate (velum) elevates closing the oropharynx from the nasopharynx and preventing nasal regurgitation. When this fails to close completely, it is known as velopharyngeal insufficiency.
Long-term patient-reported outcomes after anterior distraction osteogenesis of the maxilla in patients with cleft
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Lina Yasin, Magnus Becker, Henry Svensson, Anna-Paulina Wiedel
The literature search regarding previous studies on patient-reported outcomes of the RED device experience resulted in two relevant original articles. One study reported on nine CLP patients’ satisfaction with the RED device [10]. The authors used a self-made questionnaire based on in-depth interviews with three of the patients. Seven patients experienced negative attention in civic situations and difficulties in everyday activities during treatment. One patient reported having poorer speech due to velopharyngeal insufficiency after DO. Seven of nine patients were satisfied with their overall aesthetic outcomes. Eight patients were satisfied with the overall results and said they would undergo the same treatment again. The study has great similarities with our present one in terms of design and outcomes. Patients are generally happy with the RED procedure but both studies also show that the RED device causes difficulties in specific everyday activities and attracts people’s attention. Furthermore, both studies report on speech impairment after treatment. The previous study neither mentions anything about the patients’ satisfaction with their noses and lips after treatment, nor does it say anything about rhinoplasty and lip plasty after DO.
Comparison of postoperative pain scores and dysphagia between anterior palatoplasty and uvulopalatal flap surgeries
Published in Acta Oto-Laryngologica, 2018
Elvan Yüksel, Murad Mutlu, Ömer Bayır, Melike Yüceege, İstemihan Akın, Güleser Saylam, Ali Özdek, Hikmet Fırat, Mehmet Hakan Korkmaz
After soft palate surgeries, in early periods, some problems such as bleeding, wound infection, suture dehiscence and nasal regurgitation due to velopharyngeal insufficiency may be seen. On the other hand, in late periods, dryness and feeling stuck in throat, foreign body sensation on throat, persistent velopharyngeal insufficiency and voice alterations may occur. In our study, there was no statistically significant difference between AP and UPF groups regarding early complication rates. In late periods, dryness and abnormal sensations in the throat were reported in patients. However, those symptoms did not affect the daily life quality of patients much. Any symptoms associated with the velopharyngeal insufficiency were not determined in any of our patients in the long term. No serious complications following AP procedure were reported in the literature. In a study of Neruntarat [8] on 83 patients who had UPF, transient nasal regurgitation rate was 6% (5/83) , dysphagia rate was 4.8% (4/83) and foreign body sensation on throat rate was determined as 8.4% (7/83) . However, all those symptoms were reported to improve in a few months.
Validity of test stimuli for nasalance measurement in speakers of Jordanian Arabic
Published in Logopedics Phoniatrics Vocology, 2018
Fadwa A. Khwaileh, Firas S. D. Alfwaress, Ann W. Kummer, Ma’moun Alrawashdeh
Results of the current study confirm the validity of both the Spring Passage and Home Passage for obtaining nasalance scores for Jordanian speakers of Arabic as proved by their strong correspondence with perceptual rating of hypernasality. Thus, both passages can be utilized in clinical setting as a part of a protocol for evaluating velopharyngeal insufficiency. Results also provide further evidence for the reliability of the Nasometer in differentiating hypernasality from normal speech resonance. This suggests that careful assessment protocol for velopharyngeal function should use the Nasometer as a supplement for the clinical perceptual judgment without replacing it, as nasalance values can be exaggerated by articulation errors and nasal air emission. Therefore, they should be interpreted based on accompanying perceptual assessment by a qualified speech language pathologist (7).