• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.13 no.3
• /
• pp.338-345
• /
• 1991

Velopharyngeal incompetence (VPI) is a condition of inadequate functional valving between the oral and nasal cavities that results in hypernasal speech and nasal air escape. VPI is caused by the following factors ; cleft palate, soft palate defect, pharyngomegaly, velopharyngeal sphincter muscle anomaly and maxillary advancement surgery, etc. Velopharyngeal function is assessed by a variety of measures that include speech evaluation, cephalogram, airflow study, videofluoroscopy and nasoendoscopy. The management of VPI is classified into four main groups ; prosthesis, insertion of implant, palatoplasty and pharyngoplasty. Pharyngeal flap is the most common surgical procedure for correcting VPI since Schoenborn's report in 1875. We report seven cases of VPI which were treated by modified modified superiorly based pharyngeal flap with good results.

• Korean Journal of Cleft Lip And Palate
• /
• v.15 no.1
• /
• pp.39-50
• /
• 2012

A submucous cleft palate(SMCP) is characterized by a midline deficiency or lack with/without incorrect positioning of muscular tissues in the soft palate, and by a bony defect in the midline or the center of the hard palate. Velopharyngeal incompetence(VPI) related to this SMCP has been managed by various surgical and prosthetic techniques. Because the individual diagnosis and treatment of SMCP patients was not easy to the speech pathologist and to the maxillofacial reconstructive surgeons, and for the better understanding and for the ideal approaches to the SMCP patients, we reviewed several recent articles about grading system in the SMCP caused by VPI, and summarized in this review article.

• Speech Sciences
• /
• v.7 no.3
• /
• pp.219-228
• /
• 2000

Assessment of speech nasality provides important information for the treatment of velopharyngeal incompetence. Objective procedures may be used to assess velopharyngea1 function, in examples Nasometer, Aerodynamics, x-ray, Electromyography, Nasoendoscopy and Videofluoroscopy etc. The aim of this study was to obtain comprehensive nasalance data for Korean adults, aged 20 years and to investigate any gender differences within that age group using Nasometer II. The results were as follow: (1) The nasalance of the vowels(/a/, /i/, /e/, /o/, /u/, /ja/, /je/, /wi/) in the group of adults was higher in females than in males (p<0.05). (2) The nasalance of the plosives (/p/, /$p^h$/, /p'/, /t/, /$t^h$/, /t'/, /k/, /$k^h$/, /k'/) in the group of adults was higher in females than in males (p<0.05). (3) The nasalance of the affricatives (/c/, /$c^h$/, /c'/) in the group of adults was higher in females than in males (p<0.05). (4) The nasalance of the fricatives (/s/, /s'/, /$\int$/) in the group of adults was higher in female than in males (p<0.05). (5) There was no statistically significant effect for the nasalance of nasal consonants (/m/, /n/, /$a{\eta}$/).

• Journal of the korean academy of Pediatric Dentistry
• /
• v.27 no.4
• /
• pp.517-523
• /
• 2000

Nasopharyngeal closure is a sphincter mechanism between the activities of the soft palate, lateral pharyngeal wall and the posterior pharyngeal wall, which divides the oral cavity and the nasal cavity. It participates in physiological activities such as swallowing, breathing and pronunciation. In case of an error in this mechanism, it is called a nasopharyngeal incompetence. The causes of this error are defects in (1) length, function, posture of the soft palate (2) depth and width of the nasopharynx, (3) activity of the posterior and lateral pharyngeal wall. The purpose of this study is to analyze the nasopharynx of cleft palate patients using lateral cephalograms and at the same time, evaluate the degree of hypernasality of each vowels to find its relationship with nasopharyngeal incompetence. The following results were obtained: 1. The length of the soft palate was markedly short than normal. 2. The adequate ratio was smaller than the normal value. 3. As the adequate ratio decreased, when articulating vowels, anatomic mVPI increased. 4. When articulating each vowels, anatomic VPI was in proportion with the degree of hypernasality. 5. The degree of hypernasality was greater in high vowels(/i/, /u/) than low vowel(/a/). From the above results, it can be concluded that in cleft palate patients, lateral cephalograms can be used effectively in diagnosing and evaluating nasopharyngeal incompetence. The anatomic structure of the nasopharynx has close relation to the degree of hypernasality.

• Speech Sciences
• /
• v.7 no.4
• /
• pp.73-82
• /
• 2000

The perceptual judgement of nasality is still used in the assessment of velopharyngeal incompetence, but it should not be the sole criterion for speech nasality. Objective procedures may be used to assess velopharyngeal function, for example, nasometer, aerodynamics, x-ray, electromyography, nasoendoscopy, and videofluoroscopy can be utilized. The nasometer employs noninvasive measurement methods and measures with high levels of accuracy. The aim of this study was to obtain comprehensive nasalance data for Korean children, aged 7 years, and to investigate any gender differences within that age group. The results were as follow: 1. Statistically, gender has no significant effect on the nasalance of vowels /a/, /i/, /o/, /u/, /je/, /wi/) but the nasalance of the vowels /e/, /ja/) was higher in males (p<0.05). 2. There was no statistically significant effect of gender in plosives /p/, /ph/, /p'/, /t/, /th/, /t'/, /k/, /kh/, /k'/), affricatives /c/, /ch/, /c'/), and fricatives /s/, /s'/, /$\int$/). 3. The nasalance of the nasal consonants, /m/, /n/, /an/) is higher in males and only /n/, /an/ were statistically significant (p<0.05).

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.11 no.1
• /
• pp.81-86
• /
• 2000

Submucous cleft palate is a relatively uncommon congenital anomaly accompanying velopharyngeal incompetence(VPI). Double opposing Z-plasty has many advantages including prolongation of soft palate, normal midfacial growth, midline scar. We analyzed postoperative results comparing with those of preoperative evaluation by several variables(nasometer, endoscopy, satisfactory scale) in 14 patients treated with double opposing Z-plasty due to submcous cleft palate. Nasalance score in Ah sound, Ma phrase, and Pa phrase decreased 20.23%, 3.25%, and 23.26% in the average, respectively. As a result, hypernasality improved significantly. Closure rate in velum evaluated by endoscopy was increased from 0.44 to 0.76. In objective satisfactory scale checked by each patient's guardian at the postoperative period, much improved in 3, improved in 6, minimally improved in 1, and no difference in 1 was reported. (n=11 patients) Double opposing B-plasty is a good surgical modality in patients accompanying VPI with submucous cleft palate or incomplete cleft palate and will be used more usefully and widely.

• Archives of Plastic Surgery
• /
• v.34 no.6
• /
• pp.748-752
• /
• 2007

Purpose: The goal of palatoplasty is focused on two points. One is to close the palatal defect completely, and the other to create a velopharyngeal system for normal speech. While established methods such as pushback palatoplasty or double opposing Z palatoplasty are used in wide cleft palate repair, sequelae such as maxillary hypoplasia or oronasal fistula may result. Therefore, when palatoplasty with buccinator myomucosal flap is used in the case of wide cleft palates, maxillary hypoplasia and oronasal fistula is reduced and optimal results are obtained. Methods: From October 2005 to December 2006, four children with wide complete cleft palate underwent unilateral buccinator myomucosal flap and intravelar veloplaty. Mean age at cleft repair was 15 months, and mean cleft size was 2.15 cm. The patients underwent intravelar veloplasty and palatoplasty was done using unilateral buccinator myomucosal flap. Results: The patients, after mean 10 months of follow-up observation, showed no signs of oronasal fistula resulting from flap tension. The shape and color similar to normal oral mucosa was obtained, and velopharyngeal function was acquired. Conclusion: When intravelar veloplasty and palatoplasty with unilateral buccinator myomucosal flap is done on wide cleft palates, postoperative speech function is optimal, velopharyngeal incompetence is effectively corrected, and sequelae resulting from pushback palatoplasty and double opposing Z-plasty, such as maxillary hypoplasia and oronasal fistula, is reduced.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.13 no.1
• /
• pp.45-51
• /
• 2002

The purpose of this study is to examine the effects of vowel type on the nasalance score. Twenty one male adults without VPI produced 5 types of vowels (/a/, /e/, /i/, /o/, /u/) in two conditions-normal and simulated VPI condition. Nasalance scores were measured for each vowel. These data were compared between conditions and among vowel types. The results were as follow : For all vowels, nasalance scores were significantly higher in simulated VPI condition than in normal condition. The two conditions yielded different patterns in terms of the degree of nasalance across the 5 vowels. In normal condition, nasalance scores were higher in front vowels than in medial or back vowels. But in simulated VPI condition, nasalance scores were higher in high vowels than in mid or low vowels.

• Korean Journal of Cleft Lip And Palate
• /
• v.11 no.1
• /
• pp.1-12
• /
• 2008

In cleft palate patient, characteristic of speech disorder is the resonance disorder result from velopharyngeal incompetence. Clinically VPI caused by congenital factor as congenital palatal incompetence, submucosal cleft palate, and caused by acquired factor as CNS damage, tumor, palatal palsy. The clinicians more concerned about the speech disorders after cleft palate surgery rather than language pathologist. The resonance disorder devided for hypernasality, hyponasality and nasal emission, but as a rule, hypernasality is typical phenomenon of the resonance disorder. Traditionally clinicians and language pathologists evaluated four-stage or five-stage of hypernasality by subjective assessment. Although language pathologist is well-trained, results of the language level should be different. In late 1980s, Kay Elemetrics Corp. developed nasometer that objective nasalance identified with well-trained language pathologist and originate from nasometer Tonar I and II were developed by Fletcher. Therefore objective nasalance test was possible, the nasometer used in hospital, collage and speech clinic both and home and abroad. Standardization of the cleft palate speech assessment must be settled without delay because of different character result in different language and different assessment results by dialect in same language. In our study, we provide the data base for the standardization of cleft palate speech assessment which through report of objective assessment method, speech therapy effects and problems result in interdisciplinary teamwork by nasometer use in treatment of cleft palate patient.

• Korean Journal of Cleft Lip And Palate
• /
• v.13 no.2
• /
• pp.53-62
• /
• 2010

Nasalance is used to evaluate the velopharyngeal incompetence in clinical diagnosis using Nasometer. The aim of this study is to find the nasalance differences between English native speakers and Korean speakers by measuring the nasalance of Oral and Nasal sentences. 20 Americans and 20 Korean students participate to the experimentation. The results are as follows: (1) The nasalance of females for Oral and Nasal sentences is higher than that of males for both native and Korean speakers. (2) The nasalance of Oral sentences in Korean men and females is higher than that of Oral sentences in American men and females, however, the nasalance of Nasal sentences in American men and females is higher than that of Nasal sentences in Korean men and females. (3) The nasalance of stop consonants /p, t, k/ in Korean men and females is higher than that of consonants in American men and females. (4) The nasalance of nasal consonants /m, n, ɧ/ in American men and females is higher than that of consonants in Korean men and females.