Velopharyngeal videofluoroscopy: Providing useful clinical information in the era of reduced dose radiation and safety (original) (raw)
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Surgical Treatment of Velopharyngeal Insufficiency
Surgical Management of Head and Neck Pathologies, 2021
Velopharyngeal insufficiency (VPI) is a condition where the soft palate and posterior oropharynx fail to close adequately, leading to complications such as abnormal speech, nasal regurgitation and nasal emission. Although there exist many approaches to treating VPI depending on the shape and severity of the insufficiency, this chapter describes the three most frequently used and well-researched techniques: the Furlow Palatoplasty (double-opposing Z-palatoplasty), the creation and placement of a pharyngeal flap, and a sphincter pharyngoplasty. This chapter contains an introduction to VPI causes and treatment, a description of patient assessment methods, step-by-step instructions for the different operative procedures, and the recovery process.
Results and complications of 1104 surgeries for velopharyngeal insufficiency
ISRN otolaryngology, 2012
Velopharyngeal insufficiency (VPI) means that the velopharyngeal closure is inadequate or disturbed. VPI may be organic or functional, congenital or acquired and is caused by structural alterations or paresis. The symptoms are primarily to be found in speech (hypernasality), more rarely in swallowing and hearing. The management types are as follows: speech therapy, surgery, speech bulb, and others. Surgery is indicated if the symptoms of VPI cannot be improved by speech therapy. Among the operative methods, velopharyngoplasty constitutes the basis of the surgery. The pharyngeal flap was incorporated and survived in 98.1% of the cases, hyperrhinophony disappeared or became minimal in 90% after surgery in our material (1104 cases). The speech results seemed to be the same with superiorly or inferiorly based pharyngeal flap. The Furlow technique, push-back procedure, the sphincteroplasty, and the augmentation were indicated by us if the VP gap was less than 7 mm; these methods may also...
Velopharyngeal insufficiency: diagnosis and management
Current Opinion in Otolaryngology & Head and Neck Surgery, 2009
Purpose of Review-Journal articles relevant to the diagnosis and treatment of velopharyngeal insufficiency (VPI) were reviewed. All articles ascertained by PubMed search were included. Recent Findings-Articles reported on the application of magnetic resonance scanning, reliability tests of the International Working Group diagnostic protocol, the use of nasometry, and techniques designed to assess the function of the velopharyngeal mechanism. Treatment papers focused on outcomes in small samples of cases and complication rates from pharyngeal flap. One paper discussed ineffective speech therapy procedures. Summary-There were relatively few papers this past year. Those that were published were hindered by small and heterogeneous sample sizes, and occasionally by inappropriate methods for assessing outcomes. None of the findings will have a major impact on the current state-of-the-art for diagnosis of VPI. The speech therapy paper has a very important message that should be taken to heart by all clinicians involved in the management of children with clefts and craniofacial disorders.
Nasoendoscopy of velopharynx before and during diagnostic therapy
Journal of Applied Oral Science, 2008
asoendoscopy is an important tool for assessing velopharyngeal function. The purpose of this study was to analyze velar and pharyngeal wall movement and velopharyngeal gap during nasoendoscopic evaluation of the velopharynx before and during diagnostic therapy. Nasoendoscopic recordings of 10 children with operated cleft lip and palate were analyzed according to the International Working Group Guidelines. Ratings of movement of velum and pharyngeal walls, and size, location and shape of gaps were analyzed by 3 speech-language pathologists (SLPs). Imaging was obtained during repetitions of the syllable /pa/ during a single nasoendoscopic evaluation: (a) before diagnostic therapy, and (b) after the children were instructed to impound and increase intraoral air pressure (diagnostic therapy). Once the patients impounded and directed air pressure orally, the displacement of the velum, right, left and posterior pharyngeal walls increased 40, 70, 80, and 10%, respectively. Statistical significance for displacement was found only for right and left lateral pharyngeal walls. Reduction in gap size was observed for 30% of the patients and other 40% of the gaps disappeared. Changes in gap size were found to be statistically significant between the two conditions. In nasoendoscopic assessment, the full potential of velopharyngeal displacement may not be completely elicited when the patient is asked only to repeat a speech stimulus. Optimization of information can be done with the use of diagnostic therapy's strategies to manipulate VP function. Assuring the participation of the SLP to conduct diagnostic therapy is essential for management of velopharyngeal dysfunction.
Protocol of assessment of velopharyngeal incompetence
International Congress Series, 2003
The Phoniatric Unit, Ain Shams University, Cairo, started to use a leading protocol for the assessment of velopharyngeal incompetence (VPI) in 1995. It comprised three levels according to the complexity of the tools used. The first level consists of elementary diagnostic procedures. They are rather simple and non-invasive but essentially subjective. Despite the clinical feasibility of these procedures, an attempt to objectify the data is made utilizing the tools on the second level of assessment, namely, the clinical diagnostic aids. This level comprises video-nasofibroscopy, roentgenological methods and high fidelity audio recording of speech. The third level of assessment, namely, additional instrumental measures, uses a more sophisticated armamentarium of research tools in an attempt to quantify the qualitative, quasi-objective measures deduced from nasofibroscopy. It comprises of many parameters including acoustic nasometry, aerodynamic studies and others.
Selcuk Tip Dergisi
Amaç: Yarık damak sebebiyle ameliyat edilen hastaların yaklaşık %30’u velofarengeal yetmezlik(VFY) sebebiyle ek müdahelelere ihtiyaç duyarlar. Ameliyat öncesi planlama için radyolojik değerlendirme kesinlikle gerekirken ameliyat sonrası değerlendirmede de oldukça faydalıdır. Bu çalışmada, velofaringeal yetmezlik sebebiyle opere edilen hastalarda velofarinksin dinamik manyetik rezonans(MR) ile değerlendirilmesi ile ilgili tecrübelerimizi paylaşmayı planladık. Hastalar ve Yöntem: Nisan 2014- Mayıs 2020 tarihleri arasında VFY ile başvuran ve postoperatif dinamik MR ile değerlendirilen 17 hasta çalışmaya dahil edildi. 7 hastaya faringeal flep, 7 hastaya posterior duvar augmentasyonu (2 kıkırdak, 5 yağ grefti) ve submukoz yarık mevcut 3 hastaya myomukozal onarım yapıldı. Ameliyat öncesi ve ameliyat sonrası 3. ayda tüm hastalara dinamik MRG yapıldı. Ameliyat sonrası sonuçlar dinamik MR ile değerlendirildi. Bulgular: Bu çalışmaya ortalama yaşı 13± 2.5 (9-29) olan, 11 (%65) kadın ve 6 (%35)...
Journal of Craniofacial Surgery, 2011
Velopharyngeal insufficiency (VPI) is a common problem after cleft palate repair; secondary surgery may be needed to treat this condition. Pharyngeal flap is usually selected for cases with sagittal closure pattern, and sphincter pharyngoplasty is used for cases with coronal closure pattern, whereas cases with circular closure pattern may be puzzling. The objective of this prospective study was to assess the efficacy of tailoring the surgical technique to the preoperative velopharyngeal closure (VPC) pattern and to determine the success of sphincter pharyngoplasty for cases with circular closure pattern. This study was conducted on 48 patients, who presented with postpalatoplasty VPI; the cases were classified into 3 groups according to the VPC: group A of coronal VPC was treated with sphincter pharyngoplasty, group B of sagittal VPC was treated with pharyngeal flap, and group C that exhibited circular VPC was treated with sphincter pharyngoplasty. Speech analysis, nasalance score, and nasopharyngoscopic data were recorded preoperatively and 6 months postoperatively. Also, snoring and sleep apnea were assessed. There were no significant differences between the groups regarding the speech, nasometric, and nasopharyngoscopic data. Although snoring was significantly higher after pharyngeal flap, there was no significant difference regarding apnea. Selection of the surgical procedure depending on the type of preoperative VPC pattern for treatment of postpalatoplasty VPI is an appropriate method. In case of circular closure pattern, sphincter pharyngoplasty is the operation of choice as it has a lower incidence of postoperative snoring than pharyngeal flap.
Effective Velopharyngeal Ratio: A More Clinically Relevant Measure of Velopharyngeal Function
Journal of Speech, Language, and Hearing Research
Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP function. An effective VP (EVP) ratio may be a more appropriate indicator of normal parameters for speech. The aims of this study are to examine if the VP ratio is preserved across the age span or if it varies with changes in the VP portal and to analyze if the EVP ratio is more stable across the age span. Method Magnetic resonance imaging was used to analyze VP variables of 270 participants. For statistical analysis, the participants were divided into the following groups based on age: infants, children, adolescents, and adults. Analyses of variance and a Games–Howell post hoc test were used to compare variables between groups. Results There was a statistically significant difference ( p < .05) in all measurements between the age groups. Pairwise comparisons reported statistically significant adjacent group differences ( p < .05) for velar length, VP ratio, effective velar length, ad...
Velopharyngeal Surgery for Patients with Small Tonsils
Otolaryngology–Head and Neck Surgery, 2012
Objective: To explore the relationship between anatomical changes and treatment response in obstructive sleep apnea (OSA) patients with small tonsils (tonsil grades 0-2 according to Friedman staging system) after velopharyngeal surgery. Method: Thirty-six patients with small tonsils underwent velopharyngeal surgery that consisted of revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) and concomitant transpalatal advancement pharyngoplasty, 3-dimensional CT of upper airway, and polysomnography performed before and after surgery were obtained for comparison and analysis. Results: Overall apnea-hypopnea index (AHI) decreased from 56.8 (37.5, 70.1) to 16.1 (10.8, 33.5) ( P < .001) after surgery. The changes of several anatomical parameters differed significantly between responders and non-responders ( P < .05), and the change of minimal cross-sectional area of velopharynx (VmCSA) was independently predictive of the change of AHI ( P < .001, r2 = 0.271). The corre...