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Results for “velopharyngeal insufficiency”

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At least 19 recordsLinked to original sources
PubMed1977

Velopharyngeal insufficiency in hemifacial microsomia.

One-third of a group of 18 patients with hemifacial microsomia demonstrated velopharyngeal insufficiency of a significant degree. The ones with velopharyngeal insufficiency tended to have more severe soft tissue and skeletal deformities of the maxillary-malar complex, associated with a total unilateral palatal paralysis. Cinefluoroscopy was not helpful in diagnosing the velopharyngeal insufficiency. Fiberoptic nasopharyngoscopy, in contrast, proved to be an excellent diagnostic tool. We suggest that patients with hemifacial microsomia have a careful, periodic speech evaluation as an essential part of their overall management.

Endoscopy↗
PubMed1977

Velopharyngeal insufficiency after maxillary advancement.

This paper reports velopharyngeal insufficiency after maxillary advancement in a 16-year-old boy. It underlines the need for systematic, quantitative investigation of the effects of this new operation on speech and velopharyngeal function.

Adolescent↗
PubMed2026

A Genetic Study of 66 Individuals With Syndromic Velopharyngeal Insufficiency.

ObjectiveVelopharyngeal insufficiency (VPI) is a form of velopharyngeal dysfunction caused by anatomical anomalies in the velopharyngeal sphincter. Although genetic causes such as 22q11 deletion syndrome are recognised, the broader genetic basis remains poorly understood. This study investigated the genetic aetiology of VPI.DesignWe conducted a phenotypic search on the DECIPHER database using the term 'Velopharyngeal Insufficiency' and identified genetic variants in these patients. These were classified using ACMG guidelines. Literature searches and network analyses examined gene roles and their contribution to sphincter development.PatientsWe identified 66 patients on DECIPHER with VPI.ResultsNinety-five percent of patients presented with syndromic VPI, commonly observed phenotypes included neurodevelopmental abnormalities and facial dysmorphology. Five patients (7.6%) had cleft palate. Pathogenic or likely pathogenic variants were identified in 56.1% of those with reported genetic variants (32/57); 26.3% through copy number variants and 29.8% through sequence variants (SVs). Chromosome 22q11.2 aberrations were the most frequently observed finding in the cohort; 7 patients carried deletions and 2 carried duplications. Independent truncating SVs in KMT2A and CAMTA1 were observed in multiple individuals. Network analyses and literature review of 26 genes prioritised for potential relevance to VPI revealed 2 broad functions: regulating gene expression and signalling pathways, contributing to palatogenesis and cranial-base development.ConclusionThis study demonstrates a high rate of pathogenic or likely pathogenic genetic findings in a syndromic VPI cohort. The findings highlight several recurrent genomic regions and biologically plausible genes that may contribute to VPI beyond the well-known 22q11 deletion syndrome.

development↗
PubMed1977

Lateral defects in velopharyngeal insufficiency. Diagnosis and treatment.

A variety of surgical techniques is available for the closure of substantial velopharyngeal defects. While the use of the centrally based pharyngeal flap remains the cornerstone of surgical treatment, there are patients who have poor lateral pharyngeal wall (LPW) mobility. After surgery that uses a centrally based flap, the speech result in such patients is less than optimal, since the poorly mobile LPW does not approximate to the central flap, thus creating a lateral defect. We have added the Towne view to our protocol for cine-speech studies to study better the lateral defects. This view is perpendicular to the velopharyngeal spincter and shows the true-purse-string nature of it. The incidence of such defects in our last 40 consecutive patients is reviewed. Based on the existence of a lateral defect, recommendations are made for a system of operations in the treatment of velopharyngeal insufficiency.

Adolescent↗
PubMed1975

Speech results after Millard island flap repair in cleft palate and other velopharyngeal insufficiencies.

Twenty-four patients were evaluated for voice quality after primary palatal repair by the Millard island flap procedure. In patients with overt cleft palate, acceptable speech was obtained in 71 percent. In patients with velopharyngeal insufficiency without an overt cleft, the success rate was 60 percent. Although we consider this method reliable and useful, we have no reason to believe that it offers substantial advantages over other established procedures. We suggest that the main reason for our failures to achieve velopharyngeal competence and acceptable voice quality after a repair is the inherent hypoplasia of palatal musculature.

Adolescent↗
PubMed1979

The dynamics of Passavant's ridge in subjects with and without velopharyngeal insufficiency--a multi-view videofluoroscopic study.

Passavant's ridge was studied in 43 patients via multiview videofluoroscopy incorporating the simultaneous recording of speech. Ratings of the videotapes were made at full speed, in slowmotion, and by stop-framing. The following results were found: (1) Just as there are variable patterns of velopharyngeal closure, there were also variations in the way in which Passavant's ridge is positioned relative to the velum, and in the ridge's subsequent role in velopharyngeal narrowing or closure. (2) The ridge was the primary pharyngeal structure at the level of the velum that closed or locally narrowed the velopharyngeal portal in 37% of patients. (3) Passavant's ridge usually appeared as a structure encompassing both the lateral and posterior pharyngeal walls, and its presence was usually associated with active lateral pharyngeal wall motion. (4) Passavant's ridge was more prominent when the head was in the hyper-extended rather than the neutral position. (5) Passavant's ridge moved in a highly consistent manner, synchronous with velar movement.

Adolescent↗
PubMed1978

Conductive hearing loss in patients with velopharyngeal insufficiency.

This study involved audiologic and otologic evaluations of 77 subjects with VPI not due to overt cleft palate, aged 4-16 years. Audiological findings revealed that: 49 per cent had a hearing loss (74 per cent conductive, 16 per cent sensori neural, 10 per cent mixed) and that 18 per cent of the subjects had inconsistent audiologic findings. Otologic evaluations revealed that 44 per cent had abnormalities of the tympanic membrane. It can be concluded that the VPI subjects differed appreciably from the normal and more closely resembled a cleft palate population.

Adolescent↗
PubMed1975

Transverse pharyngeal flaps: a dynamic repair for velopharyngeal insufficiency.

During the past three years, forty-eight patients, ranging from five to thirty years of age, have undergone bilateral transverse pharyngeal pedicles to the palate. Thirty-nine patients had not had pharyngeal flaps prior to this procedure and the remaining nine patients had failure of production of acceptable speech after undergoing inferiorly or superiorly based flap operations. One patient suffered separation of the suture line. Dramatic improvement in speech has been noted in the remaining forty-seven patients. While it is difficult to compare the speech results to other procedures, a significant finding has been achievement of satisfactory speech in all nine patients referred for correction after failure with superiorly or inferiorly based flaps. Muscle survival, as evidenced by consistent electromyograph studies, demonstrated functioning double pharyngeal sphincters to control airway shunting during rapid spontaneous speech. The use of transverse pharyngeal flaps offers an obturator effect and the added benefit of active muscle for airstream control in speech function to correct nasality in cleft palate patients. Preservation of the integrity of the neuromuscular component of these pedicles assures survival of the tissue mass for its obturator effect. A modified procedure has been adapted for patients with failure of production of acceptable speech, after using inferiorly or superiorly based flaps.

Adolescent↗
PubMed2025

Current Advances in Surgical Techniques for Secondary Cleft Palate Repair: A Systematic Review.

ObjectiveTo systematically review advances in surgical techniques for secondary cleft palate repair, emphasizing their impact on velopharyngeal function, speech outcomes, and the methodological validity of speech assessments used in published studies.DesignFollowing PRISMA 2021 guidelines, six electronic databases were searched for articles from January 2012 to February 2025 using MeSH terms related to secondary cleft palate repair, velopharyngeal insufficiency, palatoplasty, and speech outcomes. Eligible studies included clinical reports with ≥10 patients undergoing secondary repair. Data on surgical methods, outcomes, and complications were extracted and qualitatively synthesized due to heterogeneity across studies.SettingAll published clinical studies evaluating secondary cleft palate repair outcomes.Patients/ParticipantsIndividuals presenting with residual velopharyngeal insufficiency, recurrent fistula, or speech dysfunction following primary palatoplasty.Main Outcome MeasuresSpeech resonance and intelligibility, velopharyngeal closure rate, fistula recurrence, donor-site morbidity, and obstructive sleep apnea risk.ResultsFourteen studies met the inclusion criteria. Palate-based re-repair with Furlow double-opposing Z-plasty and buccal myomucosal flaps improved resonance and closure in small to moderate gaps. Pharyngeal flap and sphincter pharyngoplasty achieved satisfactory closure in larger defects but increased the risk of airway obstruction. However, most studies lacked validated speech protocols or controlled for articulatory errors and fistula effects, limiting confidence in the interpretation of outcomes.ConclusionsWhile secondary repairs often improve resonance and velopharyngeal competence, evidence remains constrained by heterogeneity and non-validated assessment methods. Future multicenter research integrating standardized, speech pathologist-verified protocols is essential to establish evidence-based algorithms for secondary cleft palate repair.

Humans↗
PubMed1977

Incongruous movements of the velum and lateral pharyngeal walls.

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 pharyngeal flap or other methods for velopharyngeal insufficiency must be suited to these peculiar valving patterns based on adequate diagnostic information.

Adult↗
PubMed1978

A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome.

This report describes a pattern of similarities among 12 patients which are felt to represent a newly recognized congenital malformation syndrome. The symptoms shown most consistently by the 12 patients were overt or submuscous clefts of the secondary palate, ventricular septal defects, typical facies, and learning disabilities. Other symptoms were noted with varying frequency. The occurrence of velopharyngeal insufficiency in all twelve patients reflected poor motion in the lateral pharyngeal walls, thus necessitating specific forms of treatment. Treatment was often dependent on the extent of cardiac lesions.

Abnormalities, Multiple↗
PubMed1979

Surgical management of the hypodynamic palate.

The most successful surgical correction of velopharyngeal insufficiency (VPI) has been achieved in those patients in whom residual dynamic function of the soft palate/nasopharyngeal sphincter mechanism exists. In spite of the obvious need for rehabilitation, surgical reconstruction has often been advised against in those cases where the palate was hypodynamic or adynamic. We have developed a surgical procedure for these patients by utilizing a modification of Hogan's lateral port control pharyngeal flap method. We present the surgical considerations along with the initial application and results in four patients with hypodynamic palates of differing origins. We think that this technique extends surgical correction of VPI to the previously neglected group of patients in whom this condition is the result of a hypodynamic palate.

Adolescent↗
PubMedDate not supplied

Reconstructive procedures on the denervated gullet.

The loss of function of the vagus nerve resulting from radical tumor surgery may require some sort of pharyngeal rehabilitation. This may be accomplished by excision of the denervated muscularis as in partial pharyngectomy. This allows the remainder of the newly formed gullet to be innervated, with 80% to 90% of the innervation provided by the vagus nerve of the contralateral side. Extramucosal myotomy, temporary tracheostomy, and a bypass nasogastric feeding tube are required. However, nasal regurgitation may occur in velopharyngeal insufficiency. A technique is described by using two nasopharyngeal local flaps to narrow the velopharyngeal entrance on the paralyzed side.

Deglutition Disorders↗
PubMed1975

A telefluoroscopic study of lingual contacts made by persons with palatal defects.

Telefluoroscopic tapes were viewed to obtain evaluations of lingual contacts during the production of six consonant sounds by 69 subjects who had a history of cleft palate or velopharyngeal inadequacy. Using phonetic textbook descriptions of normal lingual contacts as standards, these observed contacts were judged to be either normal or deviant in placement, and direction of deviation was noted. Clinical records of subjects afforded medical and surgical histories as well as evaluations of the subjects' intelligibility, nasal resonance and nasal emission at the time of the taping. Evaluations of velopharyngeal adequacy made from these tapes were also available. Based on the results of this study it was concluded that some but not all speakers who have a history of palatal problems use deviant lingual contacts to produce consonant sounds. The use of deviant lingual contacts does not appear to be related to the type of palatal problem, but is significantly related to the adequacy of the velopharyngeal mechanism for speech. Those with adequate mechanisms show the least use of deviant lingual contacts, subjects with borderline adequacy show a greater use, and those with inadequate closure show the greatest use of deviant contacts. There is a significant relationship between the use of deviant lingual contacts and the presence of abnormal intelligibility and abnormal nasal resonance. The tendency toward the use of deviant lingual contacts by those with velopharyngeal insufficiency suggests that these are compensations for the inadequate valving. These compensations may increase both the intelligibility and nasal resonance problems caused by the inadequate valving. Subjects who achieved adequacy of velopharyngeal mechanism for speech before the age of mastery of consonant sounds showed significantly less tendency to use deviant contacts than those who never attained adequacy. This was reflected in intelligible speech and less tendency toward abnormal nasal resonance. It is suggested that when velopharyngeal adequacy cannot be achieved through early surgical intervention, speech therapy may be indicated to promote the development of potentially adequate articulatory patterns and to discourage the development of compensatory mechanisms.

Adolescent↗
PubMed1976

Long-term results of the island flap palatal pushback.

We analyzed all 104 island flap pushback palatal repairs done through our Facial Rehabilitation Clinic in the period from 1965 to 1971. The results were compared to those in a group of 109 standard pushback repairs. The island flap group had a higher incidence of operative complications, of velopharyngeal insufficiency, and of secondary procedures to correct the latter. (The differences between the two groups were not statistically significant, however.) In this group of patients the island flap repair offered no particular advantage over the V-Y or the Dorrance pushback; in fact, it may have been deleterious. A hypothetical explanation for these results is offered, based on possible continuing osteogenesis by the transplanted mucoperiosteum, to produce an inflexible and poorly functioning velum.

Child↗