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The Velopharyngeal Mechanism

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Cleft Lip and Palate

Abstract

Velopharyngeal function has always been a major concern in individuals with clefts that involve the palate and is an example of the need for interdisciplinary management of disorders of speech. Although disorders of velopharyngeal function resulting in hypernasal speech are common in individuals with clefts, they also occur in people with other disorders including neuromuscular diseases, trauma, and a variety of genetic disorders that can affect the movement of the palate and pharynx. As a result, individuals on cleft palate/craniofacial teams are often called upon to diagnose and treat a wide variety of disorders that have hypernasal speech as a symptom. This chapter describes the disorders that result in velopharyngeal insufficiency and methods of assessment and management.

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References

  • Argamaso RV, Levandowski GJ, Golding-Kushner KJ et al (1994) Treatment of asymmetric velopharyngeal insufficiency with skewed pharyngeal flaps. Cleft Palate J 31:287–294

    Article  CAS  Google Scholar 

  • Arvystas M, Shprintzen RJ (1984) Craniofacial morphology in the velo-cardio-facial syndrome. J Craniofac Genet Dev Biol 4:39–45

    PubMed  CAS  Google Scholar 

  • Calnan JS (1954) Submucous cleft palate. Br J Plast Surg 6:164–168

    Google Scholar 

  • Chegar BE, Shprintzen RJ, Curtis MS et al (2007) Pharyngeal flap and obstructive apnea: maximizing speech outcome while limiting complications. Arch Facial Plast Surg 9:252–259

    Article  PubMed  Google Scholar 

  • Croft CB, Shprintzen RJ, Daniller AI et al (1978) The occult submucous cleft palate and the musculus uvulae. Cleft Palate J 15:150–154

    Google Scholar 

  • Croft CB, Shprintzen RJ, Ruben RJ (1981a) Hypernasal speech following adenotonsillectomy. Otolaryngol Head Neck Surg 89:179–188

    PubMed  CAS  Google Scholar 

  • Croft CB, Shprintzen RJ, Rakoff SJ (1981b) Patterns of velopharyngeal valving in normal and cleft palate subjects: a multi-view videofluoroscopic and nasendoscopic study. Laryngoscope 91:265–271

    Article  PubMed  CAS  Google Scholar 

  • D’Antonio LL, Marsh JL, Province MA et al (1989) Reliability of flexible fiberoptic nasopharyngoscopy for evaluation of velopharyngeal function in a clinical population. Cleft Palate J 26:217–225

    PubMed  Google Scholar 

  • Golding-Kushner KJ, Argamaso RV, Cotton RT et al (1990) Standardization for the reporting of nasopharyngoscopy and multi-view videofluoroscopy: a report from an international working group. Cleft Palate J 27:337–347

    Article  PubMed  CAS  Google Scholar 

  • Havkin N, Tatum SA III, Shprintzen RJ (2000) Velophgaryngeal insufficiency and articulation impairment in velo-cardio-facial syndrome: the influence of adenoids on phonemic development. Int J Pediatr Otorhinolaryngol 54:103–110

    Article  PubMed  CAS  Google Scholar 

  • Henningsson G, Isberg A (1988) Influence of tonsils on velopharyngeal movements in children with ­craniofacial anomalies and hypernasality. Am J Orthod Dentofacial Orthop 94:253–261

    Article  PubMed  CAS  Google Scholar 

  • Kaplan EN (1975) The occult submucous cleft palate. Cleft Palate J 12:356–368

    PubMed  CAS  Google Scholar 

  • Lewin ML, Croft CB, Shprintzen RJ (1980) Velopharyngeal insufficiency due to hypoplasia of the musculus uvulae and occult submucous cleft palate. Plast Reconstr Surg 65:585–591

    Article  PubMed  CAS  Google Scholar 

  • MacKenzie-Stepner K, Witzel MA, Stringer DA et al (1987) Velopharyngeal insufficiency due to hypertrophic tonsils. A report of two cases. Int J Pediatr Otorhinolaryngol 14:57–63

    Article  PubMed  CAS  Google Scholar 

  • Mason RM, Warren D (1980) Adenoid involution and developing hypernasality in cleft palate. J Speech Hear Disord 45:469–480

    PubMed  CAS  Google Scholar 

  • Miyazaki T, Matsuya T, Yamaoka M (1975) Fiberscopic methods for assessment of velopharyngeal closure during various activities. Cleft Palate J 12:107–114

    PubMed  CAS  Google Scholar 

  • Pigott RW (1969) The nasendoscopic appearance of the normal palatopharyngeal valve. Plast Reconstr Surg 43:19–24

    Article  PubMed  CAS  Google Scholar 

  • Pigott RW, Makepeace AP (1982) Some characteristics of endoscopic and radiological systems used in elaboration of the diagnosis of velopharyngeal incompetence. Br J Plast Surg 35:19–32

    Article  PubMed  CAS  Google Scholar 

  • Pigott RW, Bensen JF, White FD (1969) Nasendoscopy in the diagnosis of velopharyngeal incompetence. Plast Reconstr Surg 43:141–147

    Article  PubMed  CAS  Google Scholar 

  • Salyer KE, Sng KW, Sperry EE (2006) Two-flap palatoplasty: 20-year experience and evolution of surgical technique. Plast Reconstr Surg 118:193–204

    Article  PubMed  CAS  Google Scholar 

  • Shprintzen RJ (1979a) Hypernasal speech in the absence of overt or submucous cleft palate: the mystery solved. In: Ellis R, Flack R (eds) Diagnosis and treatment of palato glossal malfunction. College of Speech Therapists, London

    Google Scholar 

  • Shprintzen RJ (1979b) The use of multi-view videofluoroscopy and flexible fiberoptic nasopharyngoscopy as a predictor of success with pharyngeal flap surgery. In: Ellis R, Flack R (eds) Diagnosis and treatment of palato glossal malfunction. College of Speech Therapists, London

    Google Scholar 

  • Shprintzen RJ (1982) Palatal and pharyngeal anomalies in craniofacial syndromes. Birth Defects Orig Artic Ser 18(1):53–78

    PubMed  CAS  Google Scholar 

  • Shprintzen RJ (1995) Instrumental assessment of velopharyngeal valving. In: Shprintzen RJ, Bardach J (eds) Cleft palate speech management: a multidisciplinary approach. Mosby, St. Louis

    Google Scholar 

  • Shprintzen RJ (1997) Genetics, syndromes, and communication disorders. Singular Publishing, San Diego

    Google Scholar 

  • Shprintzen RJ (2000) Velocardiofacial syndrome. Otolaryngol Clin North Am 33:1217–1240

    Article  PubMed  CAS  Google Scholar 

  • Shprintzen RJ (2001) Velo-cardio-facial syndrome. In: Cassidy SB, Allanson J (eds) Management of genetic syndromes. Wiley, New York

    Google Scholar 

  • Shprintzen RJ (2003) The origin of speech ease: evolution of the human upper airway and its functional implications for obstructive sleep apnea. Sleep Med 4:171–173

    Article  PubMed  Google Scholar 

  • Shprintzen RJ, Croft CB (1981) Abnormalities of the Eustachian tube orifice in individuals with cleft palate. Int J Pediatr Otorhinolaryngol 3:15–23

    Article  PubMed  CAS  Google Scholar 

  • Shprintzen RJ, Lencione RM, McCall GN et al (1974) A three dimensional cinefluoroscopic analysis of velopharyngeal closure during speech and nonspeech activities in normals. Cleft Palate J 11:412–428

    PubMed  CAS  Google Scholar 

  • Shprintzen RJ, Lewin ML, Croft CB (1979) A comprehensive study of pharyngeal flap surgery: tailor-made flaps. Cleft Palate J 16:46–55

    PubMed  CAS  Google Scholar 

  • Shprintzen RJ, Schwartz RH, Daniller A et al (1985a) Morphological significance of bifid uvula. Pediatrics 75:553–561

    PubMed  CAS  Google Scholar 

  • Shprintzen RJ, Siegel-Sadewitz VL, Amato J et al (1985b) Anomalies associated with cleft lip, cleft palate, or both. Am J Med Genet 20:585–596

    Article  PubMed  CAS  Google Scholar 

  • Shprintzen RJ, Sher AE, Croft CB (1987) Hypernasal speech caused by hypertrophic tonsils. Int J Pediatr Otorhinolaryngol 14:45–56

    Article  PubMed  CAS  Google Scholar 

  • Shprintzen RJ, Singer L, Sidoti EJ et al (1992a) Pharyngeal flap surgery: postoperative complications. Int Anesthesiol Clin 30:115–124

    Article  PubMed  CAS  Google Scholar 

  • Shprintzen RJ, Singer L, Sidoti EJ (1992b) Pharyngeal flap surgery: postoperative complications. Int Anesthesiol Clin 30:115–124

    Article  PubMed  CAS  Google Scholar 

  • Siegel-Sadewitz VL, Shprintzen RJ (1982) Nasopharyngoscopy of the normal velopharyngeal sphincter: an experiment of biofeedback. Cleft Palate J 19:194–201

    PubMed  CAS  Google Scholar 

  • Skolnick ML (1969) Video velopharyngography in patients with nasal speech, with emphasis on lateral pharyngeal motion in velopharyngeal closure. Radiology 93:747–755

    PubMed  CAS  Google Scholar 

  • Skolnick ML (1970) Videofluoroscopic examination of the velopharyngeal portal during phonation in lateral and base projections – a new technique for studying the mechanics. Cleft Palate J 7:803–816

    PubMed  CAS  Google Scholar 

  • Skolnick ML, McCall GN, Barnes M (1973) The sphincteric mechanism of velopharyngeal closure. Cleft Palate J 10:286–305

    PubMed  CAS  Google Scholar 

  • Tatum SA III, Chang J, Havkin N et al (2002) Pharyngeal flap and the internal carotid in velo-cardio-facial syndrome. Arch Facial Plast Surg 4:73–80

    Article  PubMed  Google Scholar 

  • Williams ML, Shprintzen RJ, Rakoff SJ (1987) Adenoid hypoplasia in the velo-cardio-facial syndrome. J Craniofac Genet Dev Biol 7:23–26

    PubMed  CAS  Google Scholar 

  • Zim S, Schelper R, Kellman R et al (2003) Thickness and histologic and histochemical properties of the superior pharyngeal constrictor muscle in velocardiofacial syndrome. Arch Facial Plast Surg 5:503–507

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Virtual Center for Velo-Cardio-Facial Syndrome, Inc., New York, NY, USA

    Robert J. Shprintzen Ph.D. (President and Chairman of the Board)

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  1. Robert J. Shprintzen Ph.D.
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Correspondence to Robert J. Shprintzen Ph.D. .

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Editors and Affiliations

  1. Paradela Street 11035, Coral Gables, 33156, Florida, USA

    Samuel Berkowitz

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© 2013 Springer-Verlag Berlin Heidelberg

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Shprintzen, R.J. (2013). The Velopharyngeal Mechanism. In: Berkowitz, S. (eds) Cleft Lip and Palate. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-30770-6_34

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  • DOI: https://doi.org/10.1007/978-3-642-30770-6_34

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-30769-0

  • Online ISBN: 978-3-642-30770-6

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