Velopharyngeal Closure and Resonance in Children Following Early Cleft Palate Repair: Outcome Measurement

Abstract

Introduction Timing of cleft palate repair and the method of speech outcome measurement in children with cleft lip and palate are much debated topics. The associated problems and quality of life in these children depend on the timing of the surgery. Aim The aim of this study was to investigate the velopharyngeal (VP) function and resonance parameters in children following early cleft palate repair. Method A total of 25 Kannada-speaking children with early repaired cleft palate were subjected to speech assessment and videofluoroscopic assessment. Perceptual speech parameters measured were severity of hypernasality and presence of nasal air emission. Videofluoroscopy was interpreted in terms of closure ratios to predict the severity of VP dysfunction. Results The analysis of videofluoroscopic images indicated that 48% of children had complete VP closure and 52% had perceptually normal resonance. A good correlation was found between the closure ratio and hypernasality. Conclusion Understanding the perceptual speech parameters and their structural correlates for outcome measurement will give better evidence for refining the existing treatment protocols. Data on a larger population are warranted for establishing predictors of optimum speech outcome.

Speech outcome evaluation in post-cleft palate closure patients with two flaps pushback technique

“…The functional goal of cleft palate surgery is to facilitate normal speech and hearing function without impairing facial growth. 8 Various factors, such as surgical technique, time of surgery, operator skill, type and size of the cleft can affect the outcome of the operation. 9 A retrospective study shows that doing a two flap mucoperiosteal palatoplasty in children with cleft palate before the age of two years old results in a better speech ability.…”

“…Perceptual assessment is considered as a gold standard for assessing the speech outcome and is commonly validated using the instrumental examination. 8 Similarly, in this study the assessment of speech function with perceptual assessment included assessment of articulation, hypernasality and language intelligence by a speech pathologist, which was validated by instrumental examination using lateral cephalometric radiographs. One of the applicable instruments to measure the velopharyngeal gap is the lateral cephalometric radiograph.…”

Evaluación perceptual de la insuficiencia velofaríngea en personas con fisura del paladar: una revisión integradora de literatura

“…Cabe destacar que las grabaciones de audio tienen la ventaja de ser almacenadas y reproducidas nuevamente, para así por ejemplo evaluar la concordancia entre e intra examinadores (Álvarez et al, 2004;Aparna et al, 2019;Bettens et al, 2016;Chapman et al, 2016;de Boer et al, 2020;Keuning et al, 1999Keuning et al, , 2002Keuning et al, , 2004Konst et al, 2003;Larangeira et al, 2016;Lee et al, 2009;Lewis et al, 2003;Medeiros et al, 2016;Nellis et al, 1992;Oliveira et al, 2016;Padilha et al, 2015;Scarmagnani et al, 2015;Sell et al, 2001Sell et al, , 2015Sinko et al, 2017), y comparar resultados luego de intervenciones quirúrgicas y protésicas para la IVF o de tratamiento fonoaudiológico para la AC (Abdali & Yaribakht, 2019;Aparna et al, 2019;Konst et al, 2003;Rullo et al, 2009;Sell et al, 2001;Trindade et al, 2014). Por otra parte, algunos estudios incluyeron el análisis mediante video, el cual tiene la ventaja de mostrar los movimientos faciales asociados a IVF y la participación de las estructuras fonoarticulatorias durante el habla, lo que permite identificar con mayor facilidad la AC y los TSH articulatorios (Álvarez et al, 2004;Aparna et al, 2019;Bettens et al, 2016;Chapman et al, 2016;John et al, 2006;Paal et al, 2005;Sell et al, 2015;Sinko et al, 2017). De acuerdo con lo anterior, se sugiere que los equipos multidisciplinarios realicen evaluaciones en vivo y complementarlas con grabaciones de audio y video en buena calidad, ya que esto último ...…”

“…El juicio perceptual se ha considerado como el procedimiento gold standard para la evaluación de la IVF (Larangeira et al, 2016;Sell, 2005). Sin embargo, es importante destacar la realización de evaluaciones instrumentales como la videofluoroscopia y videonasofaringoscopia para caracterizar el defecto anatómico y realizar la planificación quirúrgica o protésica de cada caso (Abdali & Yaribakht, 2019;Álvarez et al, 2004;Aparna et al, 2019;Hubbard et al, 2013;John et al, 2006;Kummer et al, 2003;Lipira et al, 2011;Paal et al, 2005;Paniagua et al, 2013). Además, la nasometría que permite cuantificar la nasalidad del habla mediante una medida de nasalancia, que corresponde a la cantidad relativa de energía acústica emitida desde la cavidad nasal durante el habla, la cual ha demostrado correlacionarse altamente con el juicio perceptual (de Boer et al, 2020;Larangeira et al, 2016;Sinko et al, 2017;.…”

Furlow Palatoplasty for Velopharyngeal Dysfunction Management: Auditing and Predicting Outcomes

“…All patients underwent LVFS with digital subtraction angiography, in supine position. The methodology used for the procedure has been previously described (Aparna et al, 2019). The LVFS demonstrates the relationship between the soft palate and the wall of the posterior pharynx in the sagittal plane.…”