CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION
IN CHILDREN AND ADULTS
MSHA 2013PABLO ANTONIO YSUNZA
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