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Fersing C, Thevarajah D, Sanquer E, Chapuis C, Amelot A, Fougeron C, Aljancic L, Picard A, Kadlub N. Validation of an objective assessment tool for velopharyngeal insufficiency in cleft lip and palate children. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101968. [PMID: 39002728 DOI: 10.1016/j.jormas.2024.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
The objective of this study is to utilize the Nasometer to objectively assess velopharyngeal competence, specifically through the quantification of nasalance. Initial calibration of the nasometer was conducted on American adults. The objective of this study was to validate the use of the nasometer for the objective diagnosis of velopharyngeal insufficiency (VPI) in French children born with a total cleft lip and palate and to select relevant verbal stimuli for clinical practice. MATERIAL AND METHODS The nasalance scores of 42 children aged 8 to 10 years old, born with a cleft lip and palate, were collected and compared with 50 control children. The scores were then analyzed in relation to 31 verbal stimuli from the French corpus created for this study (sentences and syllables). The most relevant threshold values were determined by receiver operating characteristic curves, which exhibited the highest sensitivity and specificity. RESULTS The results demonstrated statistically significant differences (p < 0.05) in the mean nasalance scores of the control and cleft groups for all verbal stimuli containing oral phonemes. Threshold values with good diagnostic accuracy were defined, and 15 verbal stimuli were selected for use in clinical practice. CONCLUSION The nasalance threshold values defined in this study can be utilized for the objective diagnosis of velopharyngeal insufficiency (VPI) and the subsequent monitoring of French children aged 8 to 10 years old, born with a cleft lip and palate.
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Affiliation(s)
- C Fersing
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker Enfants malades, 75015 Paris, France; CRMR MAFACE, Hôpital Necker Enfants malades, 75015 Paris, France
| | - D Thevarajah
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker Enfants malades, 75015 Paris, France; CRMR MAFACE, Hôpital Necker Enfants malades, 75015 Paris, France
| | - E Sanquer
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker Enfants malades, 75015 Paris, France; CRMR MAFACE, Hôpital Necker Enfants malades, 75015 Paris, France
| | - C Chapuis
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker Enfants malades, 75015 Paris, France; CRMR MAFACE, Hôpital Necker Enfants malades, 75015 Paris, France
| | - A Amelot
- Laboratoire de Phonétique et Phonologie UMR 7018- CNRS/Sorbonne Nouvelle
| | - C Fougeron
- Laboratoire de Phonétique et Phonologie UMR 7018- CNRS/Sorbonne Nouvelle
| | - L Aljancic
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker Enfants malades, 75015 Paris, France; CRMR MAFACE, Hôpital Necker Enfants malades, 75015 Paris, France
| | - A Picard
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker Enfants malades, 75015 Paris, France; CRMR MAFACE, Hôpital Necker Enfants malades, 75015 Paris, France; Université Paris Cité, Paris, France
| | - N Kadlub
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker Enfants malades, 75015 Paris, France; CRMR MAFACE, Hôpital Necker Enfants malades, 75015 Paris, France; Université Paris Cité, Paris, France.
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Li J, Rodriguez G, Han X, Janečková E, Kahng S, Song B, Chai Y. Regulatory Mechanisms of Soft Palate Development and Malformations. J Dent Res 2019; 98:959-967. [PMID: 31150594 PMCID: PMC6651766 DOI: 10.1177/0022034519851786] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Orofacial clefting is the most common congenital craniofacial malformation, appearing in approximately 1 in 700 live births. Orofacial clefting includes several distinct anatomic malformations affecting the upper lip and hard and soft palate. The etiology of orofacial clefting is multifactorial, including genetic or environmental factors or their combination. A large body of work has focused on the molecular etiology of cleft lip and clefts of the hard palate, but study of the underlying etiology of soft palate clefts is an emerging field. Recent advances in the understanding of soft palate development suggest that it may be regulated by distinct pathways from those implicated in hard palate development. Soft palate clefting leads to muscle misorientation and oropharyngeal deficiency and adversely affects speech, swallowing, breathing, and hearing. Hence, there is an important need to investigate the regulatory mechanisms of soft palate development. Significantly, the anatomy, function, and development of soft palatal muscles are similar in humans and mice, rendering the mouse an excellent model for investigating molecular and cellular mechanisms of soft palate clefts. Cranial neural crest-derived cells provide important regulatory cues to guide myogenic progenitors to differentiate into muscles in the soft palate. Signals from the palatal epithelium also play key roles via tissue-tissue interactions mediated by Tgf-β, Wnt, Fgf, and Hh signaling molecules. Additionally, mutations in transcription factors, such as Dlx5, Tbx1, and Tbx22, have been associated with soft palate clefting in humans and mice, suggesting that they play important regulatory roles during soft palate development. Finally, we highlight the importance of distinguishing specific types of soft palate defects in patients and developing relevant animal models for each of these types to improve our understanding of the regulatory mechanism of soft palate development. This knowledge will provide a foundation for improving treatment for patients in the future.
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Affiliation(s)
- J. Li
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - G. Rodriguez
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - X. Han
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - E. Janečková
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - S. Kahng
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - B. Song
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Y. Chai
- Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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Abstract
PURPOSE This study was designed to investigate the effect of palatal lift prosthesis (PLP) on the speech of individuals with different types of dysarthria. PARTICIPANTS Thirty (19 males and 11 females) native speakers of Jordanian Arabic with dysarthria participated in the study. The age of the participants ranged from 8 to 67 years with an average of 34.1 years. Traumatic brain injury was the most common etiology of dysarthria among 12 participants, stroke among 11, multiple sclerosis among 3, and pseudobulbar palsy among 2; 1 participant had Parkinson disease, and another participant had amyotrophic lateral sclerosis. METHODS Five acoustic and aerodynamic measures were evaluated to determine the speech outcomes including nasalance scores, sequential motion rate, speech rate, vital capacity, and sound pressure level. The acoustic measures were obtained from the participants in PLP-out and PLP-in conditions. RESULTS Results showed statistically significant decrease in the nasalance scores of the syllable repetition, vowel prolongation, and sentence repetition tasks in the PLP-in condition below the 28% cutoff score. Furthermore, results revealed statistically significant increase in sequential motion rate, speech rate, vital capacity, and sound pressure level (P = 0.000). CONCLUSION The use of PLP is an effective treatment option of dysarthric speech. Besides nasalance scores, the sequential motion rate, speech rate, vital capacity, and sound pressure level are considered reliable speech measures that may be used to evaluate the effect of PLP on dysarthria.
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Logjes RJH, van den Aardweg MTA, Blezer MMJ, van der Heul AMB, Breugem CC. Velopharyngeal insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap. J Craniomaxillofac Surg 2016; 45:1-7. [PMID: 27939039 DOI: 10.1016/j.jcms.2016.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/21/2016] [Accepted: 10/21/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Velopharyngeal insufficiency (VPI) is common (20-30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for velopharyngeal insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage. MATERIALS AND METHODS Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and velopharyngeal closure were evaluated by a multidisciplinary cleft palate team. RESULTS Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip-palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P < 0.0001) and by parents (2.1 ± 0.9 vs 3.2 ± 0.7; P < 0.0001). Mean level of resonance improved significantly (0.7 ± 0.9 vs 2.0 ± 1.0; P < 0.0001), and velopharyngeal closure improved in 83% postoperatively. CONCLUSION The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.
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Affiliation(s)
- Robrecht J H Logjes
- Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Maaike T A van den Aardweg
- Division of Ear-Nose and Throat Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Meike M J Blezer
- Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Anne M B van der Heul
- Speech Pathology, Division of Pediatric Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, The Netherlands
| | - Corstiaan C Breugem
- Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Abou-Elsaad T, Afsah O, Baz H, Mansy A. Evaluating the diagnostic accuracy of Arabic SNAP test for children with hypernasality. Int J Pediatr Otorhinolaryngol 2016; 85:99-102. [PMID: 27240505 DOI: 10.1016/j.ijporl.2016.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/23/2016] [Accepted: 03/27/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED Nasometry is a method of measuring the acoustic correlates of resonance through a computer-based instrument called nasometer. High nasalance scores in comparison to normative data suggest hypernasality and/or other nasality disorders, while low scores suggest hyponasality. Normative values of nasalance for Egyptian Arabic speakers were established using the Arabic SNAP (Simplified Nasometric Assessment Procedures) test. OBJECTIVES to evaluate the diagnostic accuracy of Arabic SNAP test to allow for its use in the differentiation between normal and hypernasal speech in Egyptian Arabic-speaking children. METHODS Nasalance scores of normal children (n=92) on Arabic SNAP test were compared to those of 30 children with velopharyngeal insufficiency due to cleft palate. Receiver operating characteristic (ROC) curve was used to determine cutoff points with the highest sensitivity and specificity. RESULTS Statistically significant differences were found between both groups for all items in nasometric evaluation (p<0.05) except for prolonged/m/sound (p>0.05). Cutoff points were determined and certain items were selected for routine nasometric evaluation. CONCLUSION The Arabic SNAP test is a sensitive and specific tool for evaluation of children with hypernasality and can be used for both diagnosis and follow up of these cases.
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Affiliation(s)
- Tamer Abou-Elsaad
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
| | - Omayma Afsah
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Hemmat Baz
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Alzahraa Mansy
- Phoniatric Unit, ORL Department, Mansoura General Hospital, Mansoura, Egypt
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Lima-Gregio AM, Marino VCDC, Pegoraro-Krook MI, Barbosa PA, Aferri HC, Dutka JDCR. Nasalance and nasality at experimental velopharyngeal openings in palatal prosthesis: a case study. J Appl Oral Sci 2012; 19:616-22. [PMID: 22230996 PMCID: PMC3973463 DOI: 10.1590/s1678-77572011000600012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 08/09/2011] [Indexed: 11/21/2022] Open
Abstract
The use of prosthetic devices for correction of velopharyngeal insufficiency (VPI) is
an alternative treatment for patients with conditions that preclude surgery and for
those individuals with a hypofunctional velopharynx (HV) with a poor prognosis for
the surgical repair of VPI. Understanding the role and measuring the outcome of
prosthetic treatment of velopharyngeal dysfunction requires the use of tools that
allow for documenting pre- and post-treatment outcomes. Experimental openings in
speech bulbs have been used for simulating VPI in studies documenting changes in
aerodynamic, acoustic and kinematics aspects of speech associated with the use of
palatal prosthetic devices. The use of nasometry to document changes in speech
associated with experimental openings in speech bulbs, however, has not been
described in the literature.
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Bunton K, Story BH. The relation of nasality and nasalance to nasal port area based on a computational model. Cleft Palate Craniofac J 2011; 49:741-9. [PMID: 21970695 DOI: 10.1597/11-131] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the relation of perceptual ratings of nasality by experienced listeners, measures of nasalance, and the size of the nasal port opening for three simulated English corner vowels, /i/, /u/, and /a/. DESIGN Samples were generated using a computational model that allowed for exact control of nasal port size and a direct measure of nasalance. Perceptual ratings were obtained using a paired-stimulus presentation. PARTICIPANTS Five experienced listeners. MAIN OUTCOME MEASURES Measures of nasalance and perceptual nasality ratings. RESULTS Differences in nasalance and perceptual ratings of nasality were noted among the three vowels, with values being greater for the high vowels /i/ and /u/ compared to the low vowel /a/. Listeners detected nasality for the high and low vowels simulated with nasal port areas of 0.01 and 0.15 cm(2), respectively. Correlations between ratings of nasality and nasalance were high for all three vowels. CONCLUSIONS Results of the present study show a high correlation between ratings of nasality and measures of nasalance for nasal port areas ranging from 0 to 0.5 cm(2). The correlations were based on sustained vowel samples. The restricted speech sample limits generalization of the findings to clinical data; however, the results are a demonstration of the usefulness of modeling to understand the perceptual phenomena of nasality.
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Affiliation(s)
- Kate Bunton
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tuscon, AZ 85721-0071, USA.
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Velopharyngeal insufficiency: current concepts in diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2008; 16:530-5. [DOI: 10.1097/moo.0b013e328316bd68] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Suwaki M, Nanba K, Ito E, Kumakura I, Minagi S. The effect of nasal speaking valve on the speech under experimental velopharyngeal incompetence condition. J Oral Rehabil 2008; 35:361-9. [PMID: 18405272 DOI: 10.1111/j.1365-2842.2008.01846.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Velopharyngeal incompetence (VPI) is a contributing factor to speech disorders, frequently accompanying disorders, such as cleft palate, congenital paralysis of the soft palate, and cerebrovascular disease. For the treatment of these types of dysarthria, a Nasal Speaking Valve (NSV), which regulates nasal emission utilizing one-way valve, has been reported to be effective. As the unpleasantness while wearing the NSV was less than that with the conventional Palatal Lift Prosthesis, the NSV could be worn for a longer period of time. As NSV is inserted into the nostrils, this device could easily be provided for edentulous patients. This study aimed to evaluate the effect of NSV on experimentally induced VPI condition. Intelligibility of monosyllabic speech, intelligibility of conversational speech, nasalance score and acoustic analysis were used to evaluate the effect of NSV. Local infiltration anaesthesia was achieved to the area of levator veli palatini muscle and tensor veli palatine muscle of seven adult male subjects. In all subjects, remarkable suppression of the soft palate movement could be observed after the local infiltration anesthesia. Although the utterance supported by NSV under the experimentally induced VPI condition was less natural than the normal utterance, the intelligibility was markedly improved by the device. From the results of this study, the acoustic properties of NSV on the pure VPI condition, which was enabled by the newly established experimental induction, were revealed. This experimental model was also proved to provide a basis for the improvement in the treatment modalities for VPI.
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Affiliation(s)
- M Suwaki
- Department of Occlusal and Oral Function Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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