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Velopharyngeal Insufficiency

Incompetence Palatopharyngeal


Presentation

  • Strategies for classifying and treating articulation disorders in patients with cleft palate are presented.[ncbi.nlm.nih.gov]
Soft Tissue Swelling
  • Plain radiographs demonstrated soft-tissue swelling in the retropharyngeal space, which resolved at 1 month.[ncbi.nlm.nih.gov]
Soft Tissue Mass
  • On CT, dextranomer/hyaluronic acid copolymer implants appeared as bilateral nasopharyngeal soft-tissue masses isoattenuated to hypoattenuated relative to muscle in 80% (4/5) of patients.[ncbi.nlm.nih.gov]
Pediatric Disorder
  • Velopharyngeal insufficiency (VPI) is an uncommon pediatric disorder often associated with congenital syndromes. After speech therapy, surgery is the standard management.[ncbi.nlm.nih.gov]
Short Arm
  • The dominant form is linked to a gene located on a large region of chromosome 22q11.2 The X – linked form is associated with mutations of the MD1 gene, located on the short arm of the X chromosome (Xp22.2).[omicsgroup.org]
Sparse Hair
  • Individuals typically have varying combinations of ectodermal dysplasia (subjective hypohidrosis, nail dysplasia, sparse hair, tooth abnormalities), cleft lip/palate, split-hand/foot malformation/syndactyly, lacrimal duct obstruction, hypopigmentation[ncbi.nlm.nih.gov]
Onychotillomania
  • […] disobedience, aggression, toileting difficulties, and self-injurious behaviors (SIB) including self-hitting, self-biting, and/or skin picking, inserting foreign objects into body orifices (polyembolokoilamania), and yanking fingernails and/or toenails (onychotillomania[ncbi.nlm.nih.gov]
Foreign Body Sensation
  • Other sequelae, such as foreign body sensation, may be one of the most frequently expected complications after UPPP surgery.[ncbi.nlm.nih.gov]
Polyembolokoilamania
  • […] including frequent outbursts/temper tantrums, attention seeking, disobedience, aggression, toileting difficulties, and self-injurious behaviors (SIB) including self-hitting, self-biting, and/or skin picking, inserting foreign objects into body orifices (polyembolokoilamania[ncbi.nlm.nih.gov]
Broad Nasal Bridge
  • The most characteristic clinical features of OS are facial anomalies including hypertelorism, broad nasal bridge, frontal bossing and cleft lip and palate as well as laryngo-tracheo-esophageal abnormalities and hypospadias.[omicsgroup.org]

Workup

  • If there is concern for residual VPI, the subsequent evaluation proceeds in a fashion identical to the pre-operative workup to determine the best available treatment course. Future efforts to standardize.[jclpca.org]
  • After a thorough review of the patient's history, the standard workup involves perceptual speech evaluation, followed by video nasoendoscopy (VNE) and multiview speech videofluoroscopy (SVF). 7 , 8 There is considerable variation in the utilization of[ncbi.nlm.nih.gov]

Treatment

  • Successful treatment was the absence of VPI during playing as visualized by flexible nasopharyngoscopy.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis The combination of surgery to correct the insufficiency and speech therapy to retrain the voice successfully alleviate velopharyngeal insufficiency. Key terms Adenoids — Lymph glands just above the tonsils and the palate.[medical-dictionary.thefreedictionary.com]
  • Speech prognosis and need of pharyngeal flap for non syndromic vs syndromic Pierre Robin Sequence. J Pediatr Surg. 2008; 43 :668–674. [ PubMed ] 29. Shprintzen RJ. The fallibility of clinical research.[ncbi.nlm.nih.gov]
  • Perhaps in the future, measures of intraoral air pressure and/ or nasal airflow may be used to facilitate diagnosis of faulty palatopharyngeal valv-ing and prognosis of deviate valving and distorted pressure flow features relative to communication.[cleftpalatejournal.pitt.edu]
  • […] improve velopharyngeal function and is also important in correcting compensatory articulation habits that develop as a result of longstanding VPI. 1 A multidisciplinary approach when used for the treatment of any deep rooted pathology often gives good prognosis[synapse.koreamed.org]

Etiology

  • Our proposed etiology for the respiratory failure is air tracking from the flap donor site to the pleural spaces of the thoracic cavity via the visceral or prevertebral fascia following positive pressure ventilation.[ncbi.nlm.nih.gov]
  • Most common etiology of VPI was secondary to cleft palate. Some studies included patients with velocardiofacial syndromes. Improvements in speech and nasalance were reported in a majority of patients. Major complications were rare.[miami.pure.elsevier.com]
  • An overview of common etiologies follows. Overt cleft palate, either before or after repair, is by far the most common cause of VPD. This condition occurs in approximately 1 of 2000 live births.[emedicine.medscape.com]

Epidemiology

  • Epidemiology Because VPD is multifactorial, the frequency is unknown. For functional causes, determining the frequency is impossible, because some etiologies are acquired and some are congenital.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Differing only in location, the proposed pathophysiologic mechanism of injury is identical to that of the nasogastric tube syndrome, a rare and serious, well described entity consisting of bilateral vocal fold paralysis due to pressure-induced ulceration[ncbi.nlm.nih.gov]
  • Pathophysiology Oral resonance (as contrasted to nasal resonance) is obtained by velopharyngeal closure (VPC), a seal between the nasopharynx and the oral cavity.[emedicine.medscape.com]
  • . • This may not be significant pathophysiologically but may be bothersome to the significant other if the snoring prevents the other’s normal and restful sleep. • Upper airway resistance syndrome develops when more significant resistance occurs without[slideshare.net]

Prevention

  • As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.[ncbi.nlm.nih.gov]
  • When talking, the lateral ports close to prevent air escape.[fauquierent.net]

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