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Case 2.9
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
What are the pharyngeal options for patients with persistent hypernasality, and which will you choose?These include: sphincter pharyngoplasties, orposterior pharyngeal flaps.There is yet further controversy on the optimal option with no strong evidence regarding the superiority in outcome of either.My rationale will depend on the velopharyngeal closure pattern seen on nasoendoscopy and vidofluoroscopy, even though I accept that there is no strong evidence that this makes any difference to results.I will opt for a sphincter pharyngoplasty technique, such as an Orticochea method, in coronal and circular closure situations to preserve palatal mobility.In sagittal closure cases, I will use a posterior pharyngeal flap technique to preserve the lateral pharyngeal wall mobility.
Clefts and craniofacial
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
During normal speech, the soft palate ascends to close off the nasopharynx, and inadequate closure causes VPI. Symptoms include Lack of voice projection and articulation.Hypernasality (rhinolalia).Audible nasal escape – only the sounds M, N and NG normally allow nasal escape in the English language.Maladaptive/compensatory substitutions, e.g. glottal stops and pharyngeal fricatives.
Movement Disorders of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Declan Costello, John S. Rubin
The usual presentation (in 80% of cases) is in the limbs, with limb weakness, fasciculations and brisk reflexes. However, 20% of cases will present with bulbar signs and symptoms; these include dysarthria (as a result of limitation of tongue movement), tongue fasciculation, dysphagia and nasal regurgitation. Voice changes can comprise a ‘wet’ sounding voice as a result of pooling of secretions in the larynx, along with a harsh and/or breathy voice quality, and often vocal tremor. Hypernasality can result from poor velopharyngeal function.
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
A previous systemic review reported no significant difference in speech between patients treated with DO or CO [3]. In the present study, three patients underwent velopharyngeal plasty after DO, indicating a disadvantage of the procedure, i.e. that it causes hypernasality requiring complementary speech improving surgery. Two patients (#7 and #9) described a worsening of their speech after DO, and both underwent velopharyngeal plasty accordingly. Also, patient #1 underwent velopharyngeal plasty after DO and the operation was actually performed in close connection to the follow-up. She reported a better speech after DO but obviously she misinterpreted the question. The effect on the velopharyngeal function by DO was not registered as a part of the routine. Patients who complained of hypernasality were investigated by a speech and language pathologist before complementary speech improving surgery was commenced.
Normative nasalance scores in Tamil-speaking Indian children
Published in Logopedics Phoniatrics Vocology, 2022
Apar Pokharel, P. Naina, Swapna Sebastain, Kamran Asif Syed, Mary John, Ajoy Mathew Varghese
Resonance disorders are related to velopharyngeal and upper airway structure and function. Resonance disorders include hypernasality, hyponasality, cul-de-dac resonance, and mixed resonance disorders. A hypernasal speech is seen in clinical populations at risk of velopharyngeal insufficiency such as cleft palate or neuromuscular dysfunction, whereas a hyponasal voice is seen in the population with reduced permeability of the upper airways like nasal obstruction due to adenotonsillar hypertrophy. The speech pathologist has an essential role in identifying and diagnosing the oronasal balance changes in different clinical populations, in order to seek appropriate treatment [1,2]. Resonance disorders especially hypernasality can significantly affect speech quality and draw negative attention from listeners [3].
Speech diagnosis and intervention in children with a repaired cleft palate: A qualitative study of Flemish private community speech–language pathologists’ practices
Published in International Journal of Speech-Language Pathology, 2022
Cassandra Alighieri, Kim Bettens, Sofie Verhaeghe, Kristiane Van Lierde
It has been acknowledge before that the diagnosis of speech disorders in children with a repaired CP ± L is inherently complex (Henningsson et al., 2008; Fitzpatrick, Coad, Sell, & Rihtman, 2020). To achieve consistency and uniformity in diagnosing and reporting speech outcomes these children, regardless of the spoken language, Henningsson et al. (2008) put forward a set of five universal speech parameters to consider, namely: hypernasality, hyponasality, audible nasal air emission and/or nasal turbulence, consonant production errors and voice disorders. Unfortunately, this assessment protocol has not been validated (Dudas, Deleyiannis, Ford, Jiang, & Losee, 2006; Fitzpatrick et al., 2020; Prathanee, Lorwatanapongsa, Anantapong, & Buakanok, 2011). A recent systematic review by Fitzpatrick et al. (2020) explored the assessment practices for speech in 3-year-old children with a repaired CP ± L and found that a medical model and linguistic approaches were often central in the speech assessments. The review highlighted the importance of considering developmental and functional approaches. The authors concluded that, while there is a consensus as to the parameters of speech assessments (i.e. consonant production, resonance, nasal airflow, velopharyngeal function, intelligibility, and voice), there is no such consensus regarding speech samples or methods of speech assessment.