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ISSN 2992-8559 (Electronic)
ISSN 1405-0625 (Print)

2006, Number 1

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Cir Plast 2006; 16 (1)

Dysfunction of the velopharyngeal sphincter and its treatment

Ysunza A, Pamplona MC

Language: Spanish
References: 39
Page: 62-68
PDF size: 111.68 Kb.


ABSTRACT

Cleft palate is one of the most frequent congenital anomalies. In cleft palate cases there is a dysfunction of the velopharyngeal sphincter for speech production. This dysfunction is due to the structural disorder produced by the cleft and has been named velopharyngeal insufficiency. Cleft palate surgical repair provides a functional restoration of the sphincter in 80-90% of the cases. The remaining cases persist with a residual velopharyngeal insufficiency. Velopharyngeal insufficiency produces magnified nasal resonance during speech. Moreover, the insufficiency can also produce a phonological disorder involving not only the sphincter but the entire vocal tract. The phonological disorder is known as compensatory articulation. Residual velopharyngeal insufficiency requires surgical treatment. Compensatory articulation requires speech therapy. In this paper, variation of velopharyngeal dysfunction is revised, focusing on physiology and pathology of velohparyngeal insufficiency. Surgical options for the treatment in cases of residual velopharyngeal insufficiency and the importance of correcting compensatory articulation through speech intervention prior to the planning of surgical treatment are discussed. Some specific situations related to velopharyngeal insufficiency are revised, such as submucous cleft palate and velocardiofacial syndrome or 22q11.2 deletion.


REFERENCES

  1. Ysunza A, Pamplona M. Diagnóstico y tratamiento de los trastornos de articulación en el niño con paladar hendido. México: Porrúa 2000: 132.

  2. Kuehn DP, Moller KT. Speech and language issues in the cleft palate population: the state of the art. Cleft Pal Craniofac J 2000; 37: 348-1-348-35

  3. Shprintzen RJ. Cleft palate management: A multidisciplinary approach. St. Louis: Mosby, 1996: 59-83.

  4. Bzoch KR. Communicative disorders related to cleft palate. Boston: Little Brown & Co.

  5. Pamplona M, Ysunza A, González M. Linguistic development in cleft palate children with compensatory articulation. Int J Ped Otorhinolaryngol 2000; 54: 81-91.

  6. Norris J, Hoffman P. Whole language intervention for school age children. San Diego: Singular, 1993: 341.

  7. Trost-Cardamone JE. Speech Anatomy and Physiology. In: Kernahan D, Rosentain S. Cleft lip and palate: A system of management. Baltimore: Williams and Wilkins, 1990: 45-70.

  8. Ysunza A, Trigos I, Baldizón N. Sustituciones articulatorias gruesas en el diagnóstico y tratamiento de la insuficiencia velofaríngea. Bol Med Hosp Inf Mex 1987; 44: 81-86.

  9. Pamplona M, Ysunza A, Guerrero M et al. Surgical correction of velopharyngeal insufficiency with and without compensatory articulation. Int J Ped Otorhinolaryngol 1996; 34: 53-59.

  10. García-Velasco M, Ysunza A et al. Diagnosis and treatment of submucous cleft palate. Cleft Pal J 1988; 25: 171-173.

  11. Ysunza A, Pamplona M, Ramírez E et al. Surgical treatment of submucous cleft palate. Plast Reconstr Surg 2001; 107: 9-17.

  12. Trigos I, Ysunza A, Vargas D. The Sanvenero Roselli pharyngoplasty: an electromyographic study of the palatopharyngeus. Cleft Palate J 1988; 25: 385-390.

  13. Ysunza A, Pamplona M, Molina F et al. Velopharyngeal motion after sphincter pharyngoplasty. A videonasopharyngoscopic and electromyographic study. Plast Reconstr Surg 1999; 104: 905-910.

  14. Ysunza A. Fisiología de músculos faríngeos posterior a restauración quirúrgica del esfínter velofaríngeo. Gac Med Mex 2005; 141: 195-200.

  15. Ysunza A, Pamplona M. Velopharyngeal sphincter physiology after two different types of pharyngoplasty. En Prensa (Aceptado). Int J Ped Otorhinolaryngol 2006; 70: 1031-1034.

  16. Ysunza A, Pamplona M. Change in velopharyngeal valving after speech therapy in cleft palate patients. A videonasopharyngoscopic and multiview videofluoroscopic study. Int J Ped Otorhinolaryngol 1992; 24: 45-50.

  17. Ysunza A, Vázquez MC. Velopharyngeal sphincter physiology in deaf individuals. Cleft Palate Craniofac J 1993; 30: 141-144.

  18. Ysunza A, Pamplona M, Mendoza M et al. Speech outcome and maxillary growth in patients with unilateral complete cleft lip/palate operated on at 6 versus 12 months of age. Plast Reconstr Surg 1998; 102: 670-675.

  19. Mendoza M, Azzolini C, Ysunza A. Minimal incision palatopharyngoplasty. A preliminary report. Scand J Plast Hand Surg 1999; 28: 199-203.

  20. Trigos I, Ysunza A. A comparison of palatoplasty with and without primary pharyngoplasty. Cleft Palate J 1988; 25: 163-166.

  21. Bloom L, Lahey M. Language development & language disorders. New York: John Wiley & Sons, Inc., 1978: 90.

  22. Ysunza A, Pamplona M, Silva A et al. Sensibilidad y especificidad de la endoscopia para la detección del síndrome velocardiofacial. Rev Invest Clin 2004; 56: 454-459.

  23. Ysunza A, Pamplona M, Ramírez E et al. Videonasopharyngoscopy in patients with 22q11.2 deletion syndrome (Shprintzen syndrome). Int J Ped Otorhinolaryngol 2003; 67: 911-915.

  24. VCFS Educational Foundation Web site. Httpp//www.vcfsed. org.

  25. Shprintzen RJ. Velocardiofacial syndrome. In: Cassidy SB, Allanson J (Ed): Clinical management of common genetic syndromes. New York: Wiley, 2000: 332.

  26. Shprintzen RJ. Syndrome identification for speech-language pathology. San Diego: Singular, 2000: 430.

  27. Shprintzen RJ. Genetics, syndromes, and communication disorders. San Diego: Singular, 1999: 325.

  28. Tatum SA, Chang J, Havkin et al. Pharyngeal flap and the internal carotid in velocardiofacial syndrome. Ann Facial Plast Surg 2002; 4: 73-80.

  29. Mitnick RJ, Bello JH, Golding-Kushner RJ et al. The use of magnetic resonance angiography prior to pharyngeal flap surgery in patients with velocardiofacial syndrome. Plast Reconstr Surg 1996; 97: 908-919.

  30. Ysunza A, Pamplona M, Ramirez E et al. Velopharyngeal surgery: A prospective trial of pharyngeal flaps and sphincter pharyngoplasties. Plast Reconstr Surg 2002: 110, 1401-1407.

  31. Shprintzen RJ, Lewin M, Croft C. A comprehensive study of pharyngeal flap surgery: Taylor made flaps. Cleft Pal J 1979; 16: 46-55.

  32. Ysunza A, Pamplona M, Molina F et al. Surgery for speech. Int J Pediat Othorinolaringol 2004; 68: 1499-1505.

  33. Ysunza A, Pamplona M, Femat T et al. Videonasopharyngoscopy as an instrument for visual biofeedback during speech in cleft palate patients. Int J Pediat Othorinolaryngol 1997; 41: 291-298.

  34. Trigos MI, Ysunza A, García VM. Selección del procedimiento quirúrgico para corregir la IVF basados en la actividad motora del esfínter velofaríngeo. Rev Cir Plast Iberolatinoam 1993; 19: 149-157.

  35. Ysunza A, García VM, Pamplona M et al. Obstructive sep apnea secondary to surgery for velopharyngeal insufficiency. Cleft Pal Craniofac J 1993; 30: 387-390.

  36. Golding-Kushner KJ, Argamaso R, Cotton R et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy. Cleft Pal Craniofac J 1990; 27: 337-348.

  37. Shprintzen RJ. Fallibility of clinical research. Cleft Pal Craniofac J 1991; 28: 136-142.

  38. Shprintzen RJ. Surgery for speech. The planning of operations for velopharyngeal insufficiency with emphasis on the preoperative assessment of both pharyngeal physiology and articulation. In: Ferguson, MY (Ed.): Proceedings of the British Craniofacial Society. Manchester: University of Manchester Press, 1988.

  39. Pamplona M, Ysunza A, Patiño C. Speech summer camp for treating articulation disorders in cleft palate patients. Int J Pediatr Otorhinolaryngol 2005; 69: 351-359.




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