Non-cleft causes of velopharyngeal dysfunction: Implications for treatment

Kummer, Ann W.; Marshall, J. L.; Wilson, Mark

doi:10.1016/j.ijporl.2014.12.036

Cited by 57 publications

(37 citation statements)

References 50 publications

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“…; Kummer et al. ), velopharyngeal insufficiency and submucous clefting. In addition, the presence of a seam leads to the possibility that retained epithelial islands could form cysts in the soft palate.…”

Section: Discussionmentioning

confidence: 99%

Analysis of human soft palate morphogenesis supports regional regulation of palatal fusion

et al. 2015

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It is essential to complete palate closure at the correct time during fetal development, otherwise a serious malformation, cleft palate, will ensue. The steps in palate formation in humans take place between the 7th and 12th week and consist of outgrowth of palatal shelves from the paired maxillary prominences, reorientation of the shelves from vertical to horizontal, apposition of the medial surfaces, formation of a bilayered seam, degradation of the seam and bridging of mesenchyme. However, in the soft palate, the mechanism of closure is unclear. In previous studies it is possible to find support for both fusion and the alternative mechanism of merging. Here we densely sample the late embryonic-early fetal period between 54 and 74 days post-conception to determine the timing and mechanism of soft palate closure. We found the epithelial seam extends throughout the soft palates of 57-day specimens. Cytokeratin antibody staining detected the medial edge epithelium and distinguished clearly that cells in the midline retained their epithelial character. Compared with the hard palate, the epithelium is more rapidly degraded in the soft palate and only persists in the most posterior regions at 64 days. Our results are consistent with the soft palate following a developmentally more rapid program of fusion than the hard palate. Importantly, the two regions of the palate appear to be independently regulated and have their own internal clocks regulating the timing of seam removal. Considering data from human genetic and mouse studies, distinct anterior-posterior signaling mechanisms are likely to be at play in the human fetal palate.

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Section: Discussionmentioning

confidence: 99%

Analysis of human soft palate morphogenesis supports regional regulation of palatal fusion

et al. 2015

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“…These structures are utilized for separating the oral or nasal cavities from the nasopharynx during processes such as breathing, swallowing or vocalization (Putterill and Soley, 2006; Lane and Kaartinen, 2014; Kummer et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

Recent insights into the morphological diversity in the amniote primary and secondary palates

Abramyan

Richman

2015

Developmental Dynamics

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The assembly of the upper jaw is a pivotal moment in the embryonic development of amniotes. The upper jaw forms from the fusion of the maxillary, medial nasal, and lateral nasal prominences, resulting in an intact upper lip/beak and nasal cavities; together called the primary palate. This process of fusion requires a balance of proper facial prominence shape and positioning to avoid craniofacial clefting, whilst still accommodating the vast phenotypic diversity of adult amniotes. As such, variation in craniofacial ontogeny is not tolerated beyond certain bounds. For clarity, we discuss primary palatogenesis of amniotes into in two categories, according to whether the nasal and oral cavities remain connected throughout ontogeny or not. The transient separation of these cavities occurs in mammals and crocodilians, while remaining connected in birds, turtles and squamates. In the latter group, the craniofacial prominences fuse around a persistent choanal groove that connects the nasal and oral cavities. Subsequently, all lineages except for turtles, develop a secondary palate that ultimately completely or partially separates oral and nasal cavities. Here, we review the shared, early developmental events and highlight the points at which development diverges in both primary and secondary palate formation.

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“…Kummer et al subdivided velopharyngeal dysfunction into 3 categories. Palatal insufficiency is defined as resonance and speech abnormalities due to congenital or acquired anatomical defect such as cleft palate.…”

Section: Discussionmentioning

confidence: 99%

“…Palatal incompetency is due to abnormality in the velopharyngeal closure with normal velum shape, for example, a neurophysiological disorder. Palatal mislearning is defined as a speech sound disorder, and treatment requires speech therapy only …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prosthetic Rehabilitation with Palatal Lift/Augmentation in a Patient with Neurologic/Motor Deficit Due To Cancer Therapy for Chondrosarcoma

Asfar

Hutcheson

Won

2018

Journal of Prosthodontics

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This clinical report describes the prosthetic rehabilitation of a 25‐year‐old man with a history of grade II chondrosarcoma at the skull base who had undergone surgical resection and thereafter developed velopharyngeal incompetency (VPI), dysarthria, and dysphagia. Upon baseline fiberoptic endoscopic evaluation of swallowing (FEES), the patient had an atypical pattern of VPI with minimal to no velar lift during speech, blow, or suck tasks, but near complete velar lift and seal during swallowing. A palatal augmentation prosthesis combined with a resilient palatal lift extension was fabricated to enhance speech by displacing the soft palate and to decrease hypernasality, while avoiding interference with bolus transport. A resilient wrought wire extension was necessary to accommodate the velar movement upon swallowing while keeping the integrity of the velar lift during speech. In conclusion, this unique combination prosthesis was able to help the patient's atypical pattern of VPI by improving speech and preserving swallowing function, which was confirmed during a post‐endoscopic evaluation.

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Non-cleft causes of velopharyngeal dysfunction: Implications for treatment

Cited by 57 publications

References 50 publications

Analysis of human soft palate morphogenesis supports regional regulation of palatal fusion

Analysis of human soft palate morphogenesis supports regional regulation of palatal fusion

Recent insights into the morphological diversity in the amniote primary and secondary palates

Prosthetic Rehabilitation with Palatal Lift/Augmentation in a Patient with Neurologic/Motor Deficit Due To Cancer Therapy for Chondrosarcoma

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