Velopharyngeal Sphincter

14,000,000 Leading Edge Experts on the ideXlab platform

Scan Science and Technology

Contact Leading Edge Experts & Companies

Scan Science and Technology

Contact Leading Edge Experts & Companies

The Experts below are selected from a list of 264 Experts worldwide ranked by ideXlab platform

Antonio Ysunza - One of the best experts on this subject based on the ideXlab platform.

  • Velopharyngeal valving during speech in patients with velocardiofacial syndrome and patients with non syndromic palatal clefts after surgical and speech pathology management
    International Journal of Pediatric Otorhinolaryngology, 2011
    Co-Authors: Antonio Ysunza, Maria Del Carmen Pamplona, M Santiago A Morales
    Abstract:

    A B S T R A C T Background: Velocardiofacial syndrome (VCFS) is the most common genetic syndrome associated with cleft palate. There are reports describing several anomalies associated with the palatal cleft in patients with VCFS, which can affect the characteristics of the Velopharyngeal insufficiency (VPI) in these cases. Objective: The purpose of this study is to assess Velopharyngeal Sphincter function during speech, using videonasopharyngoscopy (VNP) and videofluoroscopy (VF), in patients with VCFS, as compared with patients with non-syndromic palatal clefts (NSCP). Material and method: Twenty patients with VCFS corroborated by a FISH test were studied. All patients showed a palatal cleft. All patients had received previous management including speech therapy and palatal repair. These patients underwent a thorough clinical speech evaluation, including VNP and VF. Twenty patients with NSCP matched by sex, type of cleft and within the age range of the patients with VCFS were studied as controls. Results: From the patients with VCFS, seventeen patients showed a submucous cleft palate. Three patients showed sub-total cleft of the secondary palate. Fourteen patients (70%) showed a coronal Velopharyngeal closure pattern. Six patients (30%) showed a circular pattern. In contrast, 10 patients (50%) from the NSCP group showed a circular pattern, two of them showed a Passavant’s ridge. Seven patients (35%) showed a coronal pattern and 3 patients (15%) showed a saggital pattern. Mean velum (V) and lateral pharyngeal wall (LPW) motion were significantly decreased in patients with VCFS (V = 46% vs 71%; LPW = 14% vs 30%; P < 0.001). Size of the defect during speech was significantly increased in patients with VCFS (34.57% vs 67.37%; P < 0.001). Conclusion: Velopharyngeal valving during speech is significantly different in patients with VCFS as compared with patients with NSCP. Several anomalies associated with the palatal cleft in patients with VCFS can explain these differences. Thus, the surgical approach for repairing a palatal cleft should consider these differences. Moreover, surgical planning should be performed according to the specific findings of the Velopharyngeal Sphincter in order to improve speech outcome.

  • Fisiología de músculos faríngeos posterior a la restauración quirúrgica del esfínter velofaríngeo
    Gaceta Medica De Mexico, 2005
    Co-Authors: Antonio Ysunza
    Abstract:

    SUMMARY Introduction: Speech Velopharyngeal Sphincter restoration is generally performed by pharyngeal flap or Sphincter pharyngoplasty. Objective: Evaluate pharyngeal muscle physiology after pharyngeal flap or Sphincter pharyngoplasty using simultaneous electromyography and videonasopharyngoscopy. Material and Methods: Forty patients were studied. Twenty patients were operated on with an upper base pharyngeal flap. Twenty patients were operated on with Sphincter pharyngoplasty. The following muscles were studied: superior constrictor pharyngeus, palatopharyngeus, and levator veli palatini. Results: None of the patients studied showed electromyographic activity in the lateral flaps of tile pharyngoplasties. None showed electromyographic activity of the upper base pharyngeal flaps. AII patients demonstrated strong electromyographic activity on the superior constrictor pharyngeus and the levator veli palatini. Conclusions: Lateral pharyngeal flaps in cases of Sphincter pharyngoplasties and the central pharyngeal flap in cases of pharyngeal flaps, do not create new Sphincters for Velopharyngeal closure. The participation of these structures is passive, increasing tissue volume in specific areas, whereas their movements are caused by the contraction of the superior constrictor pharyngeus and the levator veli palatini.

  • Surgical treatment of submucous cleft palate: a comparative trial of two modalities for palatal closure.
    Plastic and reconstructive surgery, 2001
    Co-Authors: Antonio Ysunza, Macarmen Pamplona, Manuel Garcia-velasco, Mario Mendoza, Fernando Molina, Patricia Martinez, Nicolas Prada
    Abstract:

    Submucous cleft palate is a congenital malformation with specific clinical and anatomical features. It can be present with or without Velopharyngeal insufficiency. Surgical treatment of this malformation is indicated only when Velopharyngeal insufficiency has been demonstrated. This article compares two modalities of surgical treatment for submucous cleft palate. The first includes a minimal incision palatopharyngoplasty, as described in a previous report. The second combines the first technique with additional individualized Velopharyngeal surgery (individualized pharyngeal flap or Sphincter pharyngoplasty) performed simultaneously. The individualized part of the procedure was selected and performed according to the findings of videonasopharyngoscopy and multiview videofluoroscopy, as reported previously. Two hundred and three patients with submucous cleft palate were studied from 1990 to 1999. Videonasopharyngoscopy and multiview videofluoroscopy demonstrated Velopharyngeal insufficiency in 72 patients, who were randomly divided into two groups. Those in group 1 (n = 37) underwent a minimal incision palatopharyngoplasty. Patients in group 2 (n = 35) also underwent that procedure but simultaneously received individualized pharyngeal flap or Sphincter pharyngoplasty, according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. The median age of the patients from both groups was not significantly different (p> 0.5). The frequency of residual Velopharyngeal insufficiency after palatal closure was not significantly different in both groups of patients (14 percent versus 11 percent; p> 0.5). The mean size of the gap at the Velopharyngeal Sphincter during speech was not significantly different in both groups of patients before surgery (23 percent versus 22 percent; p > 0.5). After the surgical procedures, there was a nonsignificant difference between both groups of patients in mean residual size of the gap in cases of Velopharyngeal insufficiency (7 percent versus 8 percent; p > 0.5). It seems that minimal incision palatopharyngoplasty is a safe and reliable procedure for palatal closure in patients with submucous cleft palate. The use of additional individualized Velopharyngeal surgery performed simultaneously did not seem to decrease the frequency of residual Velopharyngeal insufficiency. Moreover, the residual size of the gap at the Velopharyngeal Sphincter was not significantly reduced when an additional surgical procedure was performed simultaneously with palatal closure. (Plast. Reconstr. Surg. 107: 9, 2001.)

  • Videonasopharyngoscopy as an instrument for visual biofeedback during speech in cleft palate patients
    International journal of pediatric otorhinolaryngology, 1997
    Co-Authors: Antonio Ysunza, Macarmen Pamplona, Tatiana Femat, Ivonne Mayer, Manuel Garcia-velasco
    Abstract:

    Videonasopharyngoscopy was used as an instrument for visual biofeedback during speech in cleft palate patients. Seventeen cleft palate patients were randomly selected for the study. All patients showed Velopharyngeal insufficiency (VPI), compensatory articulation (CA) and negative movement of lateral pharyngeal walls (NMLPW) during speech. Nine patients received speech therapy for correcting CA. Eight patients received speech therapy and underwent videonasopharyngoscopy as an instrument for visual biofeedback of the Velopharyngeal Sphincter. After 12 weeks, NMLPW was modified in the patients receiving speech therapy and visual biofeedback. In contrast, NMLPW was still present in eight out of nine patients receiving only speech therapy. These patients received visual biofeedback and NMLPW was corrected in all cases. After six months, all 17 patients had corrected CA during isolated speech. All patients received a tailor-made pharyngeal flap. VPI was completely corrected in 15 cases. In the two cases in which VPI was still present postoperatively, the size of the defect at the Velopharyngeal Sphincter had been significantly reduced. In these two patients, visual biofeedback was used postoperatively for increasing lateral pharyngeal walls (LPW) motion towards the borders of the flap. After 18 months since the onset of speech therapy all the patients had normal nasal resonance and normal articulation during connected speech.

  • Velopharyngeal Sphincter Physiology in Deaf Individuals
    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 1993
    Co-Authors: Antonio Ysunza, Maria Del Carmen Vazquez
    Abstract:

    Abstract Fifty-three deaf subjects with a history of prelingual profound bilateral sensorineural hearing loss, similar language habilitation with hearing aids, and normal Velopharyngeal structures underwent a study protocol including speech evaluation, behavioral pure-tone audiometry, videonasopharyngoscopy, multiview videofluoroscopy, and electromyography of the Velopharyngeal muscles. Subjects were divided into two groups: the first group included 13 subjects with normal nasal resonance or mild hypernasality (four normals and nine with mild hypernasality); the second group had subjects with severe hypernasality and severe articulation deficits. Pure-tone thresholds, Velopharyngeal closure patterns, and electromyographic activity of Velopharyngeal muscles were similar for both groups of subjects. However, in subjects with severe hypernasality, despite normal muscle activity as observed by electromyography, Velopharyngeal valving activity lacked rhythm and strength during speech. It is concluded that deaf...

Joseph E Losee - One of the best experts on this subject based on the ideXlab platform.

  • What's New in Cleft Palate and Velopharyngeal Dysfunction Management?
    Plastic and reconstructive surgery, 2017
    Co-Authors: Sanjay Naran, Matthew Ford, Joseph E Losee
    Abstract:

    After studying this article, the participant should be able to: 1. Have a clear understanding of the evolution of concepts of Velopharyngeal dysfunction, especially as it relates to patients with a cleft palate. 2. Explain the subjective and objective evaluation of speech in children with Velopharyngeal dysfunction. 3. On the basis of these diagnostic findings, be able to classify types of Velopharyngeal dysfunction. 4. Develop a safe, evidence-based, patient-customized treatment plan for Velopharyngeal dysfunction founded on objective considerations. Velopharyngeal dysfunction is improper function of the dynamic structures that work to control the Velopharyngeal Sphincter. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for Velopharyngeal dysfunction. A multidisciplinary team using multimodal instruments to evaluate Velopharyngeal function and speech should manage these patients. Instruments may include perceptual speech analysis, video nasopharyngeal endoscopy, multiview speech videofluoroscopy, nasometry, pressure-flow, and magnetic resonance imaging. Velopharyngeal dysfunction may be amenable to surgical or nonsurgical treatment methods or a combination of each. Nonsurgical management may include speech therapy or prosthetic devices. Surgical interventions could include palatal re-repair with repositioning of levator veli palatini muscles, posterior pharyngeal flap, Sphincter pharyngoplasty, or soft palate or posterior wall augmentation. Treatment interventions should be based on objective assessment and rating of the movement of lateral and posterior pharyngeal walls and the palate to optimize speech outcomes. Treatment should be tailored to specific anatomical and physiologic findings and the overall needs of the patient.

G Hoch - One of the best experts on this subject based on the ideXlab platform.

  • simultaneous electromagnetic articulography and video endoscopy a case contribution to the objective diagnosis of the Velopharyngeal Sphincter
    Journal of Orofacial Orthopedics-fortschritte Der Kieferorthopadie, 1994
    Co-Authors: W Engelke, G Hoch
    Abstract:

    An objective examination of Velopharyngeal Sphincter function (VP) is possible using a variety of signal and pictorial methods to differing degrees. Video endoscopy and videofluoroscopy are the currently accepted clinical standard. With the help of a new concept described here it is possible both to analyze VP function in the midsagittal plane using electromagnetic articulography (EMA) and also to examine simultaneously the horizontal plane video endoscopically. This multidimensional analysis of VP function is presented in a case study of a healthy test person and the timing aspects of VP closure and transverse-sagittal ratio of VP port-diameters ist reported.

  • Simultane elektromagnetische Artikulographie und Videoendoskopie
    Fortschritte der Kieferorthopädie, 1994
    Co-Authors: W. Epngelkie, G Hoch
    Abstract:

    An objective examination of Velopharyngeal Sphincter function (VP) is possible using a variety of signal and pictorial methods to differing degrees. Videoendoscopy and videofluoroscopy are the currently accepted clinical standard. With the help of a new concept described here it is possible both to analyze VP function in the midsiagittal plane using electromagnetic articulography (EMA) and also to examine simultaneously the horizontal plane videoendoscopically. This multidimensional analysis of VP function is presented in a case study of a heathy test person and the timing aspects of VP closure and transverse-sagittal ratio of VP port-diameters ist reported. Eine objektive Untersuchung des Velopharyngealen Sphinkters ist mit einer Reihe signalebender und bildgebender Verfahren in unterschiedlichem Grade möglich. Derzeitiger klinischer Standard sind Videoendoskpie und Videofluoroskopie. Mit Hilfe einer neuen Konzeption kann der Velopharyngeale Sphinkter ind er mediosagittalen Ebene mit der elektromagnetischen Arkulographie und simultan in der horizontalen Ebene videoendoskopisch untersucht werden. Die mehrdimensionale Analyse der Sphinkterfunktion wird an einer gesunden Versuchsperson als Fallbeispiel dargestellt und der Verlauf der Sphinkteraktion mit Hilfe eines transversalsagittalen Öffnungsquotienten beschrieben.

  • Simultane elektromagnetische Artikulographie und Videoendoskopie@@@Simultaneous electromagnetic articulography and videoendoscopy — a casuistical contribution to an objective diagnosis of Velopharyngeal Sphincter function: Ein kasuistischer Beitrag z
    Fortschritte der Kieferorthopadie, 1994
    Co-Authors: W. Epngelkie, G Hoch
    Abstract:

    Eine objektive Untersuchung des Velopharyngealen Sphinkters ist mit einer Reihe signalebender und bildgebender Verfahren in unterschiedlichem Grade moglich. Derzeitiger klinischer Standard sind Videoendoskpie und Videofluoroskopie. Mit Hilfe einer neuen Konzeption kann der Velopharyngeale Sphinkter ind er mediosagittalen Ebene mit der elektromagnetischen Arkulographie und simultan in der horizontalen Ebene videoendoskopisch untersucht werden. Die mehrdimensionale Analyse der Sphinkterfunktion wird an einer gesunden Versuchsperson als Fallbeispiel dargestellt und der Verlauf der Sphinkteraktion mit Hilfe eines transversalsagittalen Offnungsquotienten beschrieben.

Thomas K. Pilgram - One of the best experts on this subject based on the ideXlab platform.

  • Quantification of dynamic Velopharyngeal port excursion following Sphincter pharyngoplasty.
    Plastic and reconstructive surgery, 1998
    Co-Authors: Peter D. Witt, Jeffrey L Marsh, Harry R. Arlis, Lynn Marty Grames, Ramsey A. Ellis, Thomas K. Pilgram
    Abstract:

    The Sphincter pharyngoplasty is a surgical procedure designed to correct Velopharyngeal dysfunction. Its advocates cite the theoretical advantage of its induction of dynamic activity of the neoVelopharyngeal port, but this dynamic activity has yet to be quantitatively demonstrated in the literature. The purpose of this study was to quantify postoperative Velopharyngeal dynamism and to document the results of intervention outcome on Sphincteric excursion measurements from minimal-to-maximal orifice closure. We conducted a 7-year retrospective review of speech videofluoroscopy evaluations in patients who had undergone Sphincter pharyngoplasty in our center. Between 1989 and 1994, there were 58 patients so treated for post-palatoplasty Velopharyngeal dysfunction by two surgeons using the same operative technique. Patients for whom Sphincter pharyngoplasty was recommended fulfilled both of the following criteria: (1) Velopharyngeal dysfunction caused by an anatomic, myoneural, or combined deficiency of the Velopharyngeal Sphincter that would not be expected to be managed by speech therapy alone, and (2) preoperative videonasendoscopy and speech video-fluoroscopic studies that demonstrated large-gap coronal, circular, or bow-tie closure patterns or Velopharyngeal hypodynamism. Of the original 58 patients, 24 underwent postoperative speech videofluoroscopic evaluations with basal views. Of these, 20 of the evaluations (83 percent) were of adequate quality to be included in a research study. Still images showing maximum and minimum excursion of the Sphincter in basal view were obtained. To test for observer reliability, the speech videofluoroscopic studies were randomized and presented for measurement to the same individual on two occasions, each session separated by a 1-month time interval. Topographic imaging software was used to obtain maximum and minimum measurements to within 0.1 mm. Partitioning the variance of the data showed that measurement variability was a very small portion of the total, and that difference between the minimum and maximum values was the largest source of variability. Of the total variability in the data, 64.0 percent originated in the minimum/maximum difference, 34.3 percent came from patient variability, and only 1.7 percent resulted from original or repeat measurements. The patient variability may be exaggerated because of variability in the scale of measurement. Results of this study indicate a quantifiable and statistically significant difference in maximum-to-minimum excursion of Sphincteric closure. Sphincter pharyngoplasty appears to be dynamic in the majority of cases.

Sanjay Naran - One of the best experts on this subject based on the ideXlab platform.

  • What's New in Cleft Palate and Velopharyngeal Dysfunction Management?
    Plastic and reconstructive surgery, 2017
    Co-Authors: Sanjay Naran, Matthew Ford, Joseph E Losee
    Abstract:

    After studying this article, the participant should be able to: 1. Have a clear understanding of the evolution of concepts of Velopharyngeal dysfunction, especially as it relates to patients with a cleft palate. 2. Explain the subjective and objective evaluation of speech in children with Velopharyngeal dysfunction. 3. On the basis of these diagnostic findings, be able to classify types of Velopharyngeal dysfunction. 4. Develop a safe, evidence-based, patient-customized treatment plan for Velopharyngeal dysfunction founded on objective considerations. Velopharyngeal dysfunction is improper function of the dynamic structures that work to control the Velopharyngeal Sphincter. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for Velopharyngeal dysfunction. A multidisciplinary team using multimodal instruments to evaluate Velopharyngeal function and speech should manage these patients. Instruments may include perceptual speech analysis, video nasopharyngeal endoscopy, multiview speech videofluoroscopy, nasometry, pressure-flow, and magnetic resonance imaging. Velopharyngeal dysfunction may be amenable to surgical or nonsurgical treatment methods or a combination of each. Nonsurgical management may include speech therapy or prosthetic devices. Surgical interventions could include palatal re-repair with repositioning of levator veli palatini muscles, posterior pharyngeal flap, Sphincter pharyngoplasty, or soft palate or posterior wall augmentation. Treatment interventions should be based on objective assessment and rating of the movement of lateral and posterior pharyngeal walls and the palate to optimize speech outcomes. Treatment should be tailored to specific anatomical and physiologic findings and the overall needs of the patient.