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Biomedical subjects

D Blalock

Publications and source records attributed to D Blalock.

8 recordsLinked to original sources
PubMed1999

Uvular transposition: a new method of cleft palate repair.

This prospective study was done to determine whether a new cleft palate repair utilizing uvular transposition improved speech outcome as measured objectively by a speech pathologist. In the uvular transposition procedure, the palate was lengthened with tissue from the uvula by a double-opposing Z-plasty; an intravelar veloplasty was performed, and two-thirds of the mass of the uvula was transposed to the nasal surface of the soft palate. This procedure facilitates velopharyngeal closure by significantly lengthening the palate, anatomically reconstructing the muscles of the palate, and decreasing the palatal excursion necessary to achieve closure. Sixty-two children with a cleft palate were treated with this procedure performed by the senior surgeon between the years of 1988 and 1995. These children were then enrolled in cleft lip and palate clinic at age 2 to 3 years and blindly evaluated yearly by a single speech pathologist who specialized in pediatric speech pathology. Postoperative clinical follow-up ranged from 36 to 112 months (mean, 56.8 months). Perceptual nasal emission was found to be normal in 59 of the 62 patients (95 percent). Nasometry was performed in all 62 of these patients, and the mean score was 15.7 percent, well within the accepted normal range of 25 or less at our institution. Only two of these children (3 percent) required a pharyngeal flap for velopharyngeal insufficiency. These findings suggest that the uvula transposition cleft palate repair may result in good normalization of speech with negligible rates of velopharyngeal insufficiency.

Articulation Disorders↗
PubMed1997

Speech rehabilitation after treatment of laryngeal carcinoma.

Speech, voice, and swallowing disorders are a common dysfunction associated with laryngeal carcinoma that can significantly impact one's quality of life. This article is designed to acquaint the otolaryngology-head and neck surgeon with options and methods for communication and swallowing rehabilitation following surgical treatment for laryngeal carcinoma.

Carcinoma↗
PubMed1994

Comparative voice results after laser resection or irradiation of T1 vocal cord carcinoma.

OBJECTIVE: To compare voice results following laser resection or radiation therapy for T1a glottic carcinomas. DESIGN: Objective recordings of acoustical data that were analyzed and calculated by an acoustic analyzer and subjective scores by patients, speech therapists, surgeons, and radiation therapists are compared. SETTING: Academic medical center speech laboratory at an institution where patients had been treated. Archival files were searched and patients were solicited by letter to participate in this analysis. PATIENTS: Men treated at least 6 months previously and who were without active laryngeal disease. Criteria were unilateral vocal cord carcinomatous involvement with no subglottic, anterior commissure, or arytenoid extension and tumor invasion clinically judged to be less than half of the cordal depth. INTERVENTIONS: Thirteen patients had received approximately 63 Gy in 28 fractions, five fractions a week, with laterally opposed fields using a linear accelerator. Eleven patients had had resection of less than half of the cordal depth by using a carbon dioxide laser with a 300-microns spot size working at a 400-mm distance; 13- to 15-W power intensity with a one tenth of a second burn in a noncontinuous mode. RESULTS: No statistically significant differences between the two study groups were found. Patients and physicians subjectively rated (1 indicates normal; 5, aphonic) the quality of voices of patients in the irradiation group (1.5 and 2.0) as slightly better than the quality of voices of patients in the laser group (2.0 and 2.4). Speech pathologists rated the voices of patients in the laser and irradiation group as indistinguishable and mildly abnormal (2.75 and 2.73). CONCLUSION: Voice quality in highly selected patients with vocal cord carcinoma treated by laser resection can be as good as that in patients whose cancer was similarly staged after radiation therapy.

Carcinoma, Squamous Cell↗
PubMed1992

Voice analysis of patients with endoscopically treated early laryngeal carcinoma.

Endoscopic laser resection of early (T1) laryngeal carcinoma has been advocated as an alternative to radiotherapy. Heretofore, the voice characteristics following this procedure have been addressed in only one review, which included patients treated by irradiation and laser resection. We present the first review of voice findings in 22 patients treated only by endoscopic laser resection of their vocal cord carcinomas. Laser resection of selected vocal cord carcinomas produced voice function results acceptable to the patients and was rated by them to be normal to almost normal. Speech pathologists rated the voices to be near-normal to mildly abnormal. Voices after laser resection of vocal carcinoma exhibited a slightly higher fundamental frequency, a decrease in intensity and phonatory duration, and markedly higher laryngeal airway resistance. The percentage of voicing showed little deviation from normal, as did mean percentage of perturbations.

Airway Resistance↗
PubMed1984

Normal speech for patients with laryngeal webs: an achievable goal.

Normal speech as well as an improved airway is now an achievable goal in the treatment of laryngeal webs. Seven acquired webs and 3 congenital webs were seen at the North Carolina Baptist Hospital/Bowman Gray School of Medicine. The speech of 6 patients was tested preoperatively and again postoperatively: speech was considered normal postoperatively in 5 patients without the need for speech therapy; normal in the sixth patient after 6 sessions of speech therapy. The authors' preferred method of treatment is development of an endolaryngeal mucosal flap with a variable beam CO2 laser under operating microscopic control.

Adolescent↗
PubMed1980

The otolaryngologist's role in the diagnosis and treatment of amyotrophic lateral sclerosis.

In the early insidious phase of Amyotrophic Lateral Sclerosis (ALS), the patient will often present initially to the otolaryngologist for a presumed speech problem or dysphagia. Adult onset hypernasality, breathiness, articulation defects and voice harshness should all be seen as possible early signs of ALS and may allow the otolaryngologist to be the primary diagnostician for that disease; three such cases are reported here. Once the diagnosis of ALS is made, the otolaryngologist may be involved at different stages in the disease, offering treatment such as Teflon¿ injections, pharyngeal flap, obturator fitting, cricopharyngeal myotomy, tracheostomy, and cervical esophagostomy for speech, swallowing and aspiration problems. Although they do not halt the progression of this fatal disease, these procedures provide an improved quality of life for the patient whose intellectual function is preseved while his motor functions progressively deteriorate. This is more important for the minority of patients having prolonged survival.

Adult↗