CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION

IN CHILDREN AND ADULTS

MSHA 2013PABLO ANTONIO YSUNZA

antonio.ysunza@beaumont.edu

TERMINOLOGY

• MALFORMATION: A LOCALIZED ERROR IN MORPHOGENESIS (CLEFT PALATE)

TERMINOLOGY

• SEQUENCE: A MALFORMATION CAUSING ANOTHER MALFORMATION (S)

• PIERRE-ROBIN SEQUENCE: MICROGNATHIA—GLOSSOPTOSIS—SUB-TOTAL PALATAL CLEFT)

• DiGEORGE SEQUENCE: NEURAL CREST DEFECT—THYMUS ABSENCE, HYPOCALCEMIA, IMMUNE DEFICIENCY

TERMINOLOGY

• SYNDROME: GROUP OF MALFORMATIONS WITH COMMON ETIOLOGY (VELOCARDIOFACIAL SYNDROME-22Q11.1 DELETION)

CLEFT PALATE

• PRIMARY PALATE• SECONDARY PALATE

CLEFT PALATE

CLEFT PALATE

SUBMUCOUS CLEFT PALATE

SUBMUCOUS CLEFT PALATE

V P I

• W / COMPENSATORY ARTICULATION ERRORS (HYPERNASALITY AND ABERRANT PLACEMENT AND MANNER)

• WO / COMPENSATORY ARTICULATION ERRORS (HYPERNASALITY WITH APPROPRIATE PLACEMENT AND MANNER)

V P I + COMPENSATORY ERRORS

• PROBLEM BEYOND V P S, INVOLVES ENTIRE VOCAL TRACT AND HIGHER LEVELS OF SPEECH PRODUCTION

• SPEECH THERAPY IS INDICATED• 1/3 OF RESIDUAL V P I SHOW

COMPENSATORY ERRORS• SURGERY DO NOT MODIFY COMPENSATORY

ERRORS

VELOPHARYNGEAL SPHINCTER

• ANTERIOR: VELUM (LEVATOR VELI PALATINI AND MUSCULUS UVULAE)

• LATERAL: LATERAL PHARYNGEAL WALLS (SUPERIOR PHARYNGEAL CONSTRICTOR)

• POSTERIOR: POSTERIOR PHARYNGEAL WALL (SUPERIOR PHARYNGEAL CONSTRICTOR)

VIDEOFLUOROSCOPY

• X-RAYS• DYNAMIC ASSESSMENT (VIDEO)• ANALYSIS ON VIDEO (DECREASE TOTAL

RADIATION TIME)• FRONTAL OR CORONAL, LATERAL OR

SAGGITAL, BASE OR AXIAL

RESIDUAL V P I

• SYNDROMIC• NON SYNDROMIC

NON-SYNDROMIC V P I

• INTRAVELAR VELOPLASTY (L V P SURGICAL REPAIR)

• FURLOW Z PLASTY• PHARYNGEAL FLAP• SPHINCTER PHARYNGOPLASTY