Deglutition in Patients With Hypernasality Associated With Unilateral Cleft Lip and Palate Evaluated With High-Resolution Manometry

Abstract

Objective: To evaluate pharyngeal pressure profiles during swallowing in patients with unilateral cleft lip and palate (UCLP) and identify compensation mechanisms. Design: Prospective experimental study. Setting: University Hospital and Medical School. Participants: Ten volunteers and 10 patients with nonsyndromic repaired UCLP with hypernasality (age: 19-27 years, 5 females and 5 males per group) were included. Interventions: All participants swallowed 2 and 10 mL of water and underwent high-resolution manometry (HRM). Main Outcome Measures: Pharyngeal and upper esophageal sphincter (UES) parameters were measured using HRM. Student t test was used for statistical intergroup comparisons. Additionally, the Sydney Swallowing Questionnaire (SSQ) was used as a subjective measure. Results: Patients exhibited reduced velopharyngeal closing pressure and velopharyngeal and tongue base (TB) region contraction times, compared to volunteers ( P < .05). The UES opening and closing functions did not change. The SSQ revealed nasal regurgitation in some patients. Conclusions: In patients with UCLP, velopharyngeal region alterations are caused by impaired muscle force and function. The reduced TB contraction time may be a compensation mechanism allowing bolus transportation without nasal regurgitation. However, deglutition is not completely altered since UES function remains normal. Future studies will need to reveal at which point a decrease in velopharyngeal closing pressure will result in velopharyngeal insufficiency.

The Upper Esophageal Sphincter Distensibility Index Measured Using Functional Lumen Imaging Probe Identifies Defective Barrier Function of the Upper Esophageal Sphincter

“…16 Manomeric assessment of the UES is limited due to variability in normative data and confounding effect of UES reactivity. 12,[24][25][26] In our study, HRM UES pressures did not correlate with FLIP UES-DI in our sample. FLIP is performed during sedated upper endoscopy when UES reactivity is diminished.…”

Evaluation of Swallowing Function in Relation to Oropharyngeal Dysphagia in Patients with Operated Unilateral Cleft Lip and Palate

“…Thereby, it is possible that the opening of the UES cannot be impaired. This possibility was confirmed by a recent study that reported that the UES opening and closing pressures and relaxation time remained unchanged in patients with operated unilateral CLP monitored using high-resolution manometry 12 . However, the study also reported that although maximum pressure in the tongue base did not differ between CLP and non-CLP groups, the contraction time of the tongue base in patients with CLP was reduced, which could render the tongue driving forces inadequate.…”

“…This possibility was confirmed by a recent study that reported that the UES opening and closing pressures and relaxation time remained unchanged in patients with operated unilateral CLP monitored using high-resolution manometry. 12 However, the study also reported that although maximum pressure in the tongue base did not differ between CLP and non-CLP groups, the contraction time of the tongue base in patients with CLP was reduced, which could render the tongue driving forces in-adequate. This might be why vallecular residues were observed, especially in the present CLP group, as Dejaeger et al 32 implicated tongue-driving force as a factor contributing to vallecular residues.…”

“…5 Although a few studies have documented the prevalence of oropharyngeal dysphagia (OD) in patients with CLP using questionnaires, 4,5 a recent study evaluated the pharyngeal swallowing phase objectively via high-resolution manometry. 12 Manometric examination enables evaluation of pharyngeal intraluminal pressures and upper esophageal sphincter (UES) peristalsis, 13 whereas FEES identifies pharyngeal residues, laryngeal penetration, and laryngotracheal aspiration as a possible consequence of swallowing problems. 9,10 In patients with CLP, the inquiry is still unanswered concerning whether OD symptoms are different from those in non-cleft healthy subjects.…”

Three-dimensional analysis of the velopharyngeal region in patients with cleft palate and healthy individuals

“…We, therefore, conclude that a difference in anatomic structures persists in patients with cleft palate even after surgical closure. It can be assumed that the dimensional differences shown here also have an influence on the velopharyngeal function [10]. This, however, is subject to further studies.…”