Biomedical subjects
Publications and source records attributed to J E Riski.
The purpose of this paper is to illustrate the value of combined aerodynamic and endoscopic examination of velopharyngeal function in the revision of prosthetic speech appliances. Use of these combined measures enables the clinician to identify accurately the site(s) of any under- or overobturation. Furthermore, any needed revision is completed accurately and efficiently.
Among 47 patients with stroke evaluated clinically and videofluoroscopically, one-half aspirated. Patients with combined cerebral-brainstem strokes with bilateral cranial nerve signs were at greatest risk, but aspiration also occurred in the context of unilateral signs. Dysphonia was the common clinical characteristic of aspirating patients. Single chest roentgenograms were of limited value in predicting aspiration. Outcome was favorable following compensatory oral feeding programs.
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A primary Orticochea pharyngoplasty with a primary palatoplasty was studied in 15 children with cleft palates. Although all children demonstrated velopharyngeal competence, radiographic, endoscopic, and oral examinations suggested that 54% of the children studied would not have needed a pharyngoplasty. In addition, 27% of the children demonstrated aberrant speech patterns associated with velopharyngeal incompetence. Emphasis is placed on the difficulty in identifying which cleft palate patients will have residual velopharyngeal incompetence and the need for continued study and development of techniques for more accurate prediction of which patients would benefit from a primary pharyngoplasty.
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A modification of the insertion level of Orticochea flaps is proposed. The purpose of the modification is to place the pharyngoplasty at a higher site, in the area of attempted velopharyngeal contact. The site of velopharyngeal contact can be identified using lateral radiographic techniques. A success rate of 93 percent was achieved in improved oral-nasal resonance balance when the pharyngoplasty was placed at a site in the nasopharynx.
This longitudinal study analyzed the articulation development of 108 children with cleft lip/palate from three through eight years of age. The data suggest that as the severity of clefting increases the severity of the articulation deficit does also. Age and type of cleft were statistically significant factors in the development of normal articulation skills. Children with cleft lip appeared to be a homogeneous speaking group characterized by normal articulation development. However, children with palatal clefts remained at a heterogeneous group with regard to their articulation test performance through eight years of age. Future comparisons of articulatory proficient and articulatory deficient cleft palate children may shed light in morphological and other reasons for the articulation deficiency in some children.
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Successful treatment of head and neck deformities by the plastic and maxillofacial surgeon often involves participation of the speech pathologist and orthodontist in planning therapy and helping the patient adapt to the surgery performed. Patients are presented demonstrating the communication in treatment planning and implementation recommended between surgeon, speech pathologist, and orthodontist. We describe the tools of examination used in the Division of Plastic and Maxillofacial Surgery at Duke University Medical Center.
Longitudinal data on speech sound acquisition and oral-nasal balance were analyzed in 52 children who had had pharyngeal flaps for velopharyngeal incompetency. These data were compared to similar data for a group of 48 children with cleft palates who had not required secondary management. Comparisons were made also between the pre- and post surgical performance of the group who had had pharyngeal flaps. Further comparisons were made between children who had surgery before six years. Analysis of data revealed that the children who required pharyngeal flaps lagged behind the group who did not in the development of acceptable resonance and articulation patterns. Further analysis showed that, for the post-pharyngeal flap group, there was an acceleration in the acquisition of acceptable sound production in the year immediately following surgery. The data suggested that children who had flaps before six years of age made faster gains in the development of articulation and acceptable resonance than did children who were treated after the age of six years.
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Explore the source record for details and available documents.