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The purpose of this study was to investigate if multiple oppositions intervention (MOI) generated widespread change in the phonological systems of two children with cleft lip and palate (CLP) and severe speech sound disorders (SSD). We treated two children (ages 5;4 and 5;6) with CLP and severe SSD using MOI for 24 and 29 sessions. We measured the percentage consonants correct (PCC) for target consonants and untreated consonants in non-treatment single words, as well as PCC for connected speech. Data points were collected in the baseline, intervention, and maintenance phase with post-tests conducted immediately after intervention and at 1, 3, 6 and 12 months. Two speech and language therapists (SLTs) unfamiliar with the children performed phonetic transcriptions, and we calculated intra- and inter-rater agreement. We graphed the data, and used permutation tests to analyse the probability that the observed increases in PCC were due to random chance. Both children experienced considerable improvements in PCC across all measures at the first post-test, supporting the impact of MOI on their entire phonological system. The PCC continued to increase during the maintenance phase. By the final post-test, the PCC in connected speech exceeded 90% for both children, reducing their SSD classification to mild. Our findings support that a phonological, contrastive intervention approach targeting multiple consonants simultaneously can create system-wide phonological change for children with CLP and severe SSD. Further research with more participants is needed to strengthen these findings. [ABSTRACT FROM AUTHOR]

Introduction: The levator veli palatini (LVP) muscle has two segments with distinct roles in velopharyngeal function. Previous research suggests longer extravelar segments with shorter intravelar segments may lead to a more advantageous mechanism for velopharyngeal closure. The purpose of this study was to examine whether the distribution of the LVP intravelar and extravelar segments differs between children with cleft palate with and without VPI and controls. Methods: The study included 97 children: 37 with cleft palate +/- lip with VPI, 37 controls, and 19 with cleft palate with normal resonance. Measures included mean LVP length, mean extravelar LVP length, and intravelar LVP length. Results: Overall mean LVP length was similar (P =.267) between controls and children with cleft palate (with and without VPI). However, there was a significant difference (P <.001) between group for both intravelar and extravelar LVP lengths: the intravelar segment was significantly longer in those with VPI compared to controls and children with cleft palate and normal resonance; and the extravelar segment was significantly shorter in those with VPI compared to controls and children with cleft palate and normal resonance. Conclusions: Results from this study demonstrate a significant difference between the distribution of the functional segments of the LVP among children with VPI, with a more disadvantageous distribution of the muscle segments among those with VPI. [ABSTRACT FROM AUTHOR]

Background/Objectives: Currently, there is a lack of a comprehensive classification system for soft-palate defects that provides synthetic information to guide functional reconstructive treatment. Our awareness, shaped by extensive experience, of the superiority of myomucosal flaps to fasciocutaneous flaps in functional palate reconstruction has driven us to introduce a new defect-based classification system and propose a new algorithm for reconstructing soft-palate defects using buccinator myomucosal flaps. Methods: Soft-palate defects were classified into five classes. A reconstruction algorithm employing buccinator myomucosal flaps—including axial, island, and tunnelized flaps along with their variants as described in previous studies—was utilized. Clinical records, including tumor stage, location, defect size, and details of the myomucosal flap used, were documented. Postoperative speech intelligibility, swallowing, and quality of life (QoL) were evaluated. Donor-site morbidity and complications were also assessed. Spearman's rank correlation was employed to assess relationships between clinical parameters and functional outcomes. Results: Twenty-two patients who had undergone soft-palate resection and subsequent reconstruction were reviewed. Favorable recovery of swallowing and speech was reported in all cases, with a median deglutition score of 6.04 ± 0.85 and no severe velopharyngeal insufficiency observed (speech score: 0.36 ± 0.58). Quality of life assessments indicated satisfactory recovery across physical, social, emotional, and functional parameters. Donor-site morbidity was low (average score: 8.3), with only minor complications observed. Tumor stage showed a significant correlation with speech score (r = 0.44, p = 0.04). Conclusions: The proposed classification introduces a comprehensive, simple, and user-friendly categorization of soft-palate defects, accompanied by a myomucosal reconstructive algorithm designed to guide surgeons through the reconstructive process, aiming to provide optimal functional reconstruction. The study's small sample size and monocentric design may have limited the detection of meaningful correlations, highlighting the need for larger, multicentric studies with objective methods to validate findings. [ABSTRACT FROM AUTHOR]

Purpose: Finite element (FE) models have emerged as a powerful method to study biomechanical complexities of velopharyngeal (VP) function. However, existing models have overlooked the active contributions of the lateral pharyngeal wall (LPW) in VP closure. This study aimed to develop and validate a more comprehensive FE model of VP closure to include the superior pharyngeal constrictor (SPC) muscle within the LPW as an active component of VP closure. Method: The geometry of the velum and the lateral and posterior pharyngeal walls with biomechanical activation governed by the levator veli palatini (LVP) and SPC muscles were incorporated into an FE model of VP closure. Differing muscle activations were employed to identify the impact of anatomic contributions from the SPC muscle, LVP muscle, and/or velum for achieving VP closure. The model was validated against normative magnetic resonance imaging data at rest and during speech production. Results: A highly accurate and validated biomechanical model of VP function was developed. Differing combinations and activation of muscles within the LPW and velum provided insight into the relationship between muscle activation and closure patterns, with objective quantification of anatomic change necessary to achieve VP closure. Conclusions: This model is the first to include the anatomic properties and active contributions of the LPW and SPC muscle for achieving VP closure. Now validated, this method can be utilized to build robust, comprehensive models to understand VP dysfunction. This represents an important advancement in patient-specific modeling of VP function and provides a foundation to support development of computational tools to meet clinical demand. [ABSTRACT FROM AUTHOR]

Background and Objective: One of the challenges patients with cleft palate face is the production of intelligible speech. Though instrumental assessment of velopharyngeal function is required, there is a need to correlate the results obtained with speech outcome. The objective of this study is to correlate the Golding-Kushner scale scoring system for velopharyngeal defects as observed on nasoendoscopy with patients' speech intelligibility. Method: The design is an observational cross-sectional study conducted from December 2022 to May 2023. This study was carried out at the orofacial cleft clinic of a tertiary hospital. Participants: The study included English-speaking patients with cleft palate who had palatorrhaphy done at least 6 months before recruitment. Intervention: Speech intelligibility was measured using a simple analog scale that ranged from 0 to 5 (0—worst speech intelligibility possible, 5—best speech intelligibility). The Golding-Kushner scale is used to measure gap size (defect) in nasoendoscopy. Main outcome measures : The primary outcome is to correlate the score of speech intelligibility with the Golding-Kushner score during nasoendoscopy. Results: A total of 40 people participated in the study, with a median age of 11 years (IQR: 6.25-21.75 years). There is a moderately negative correlation between velopharyngeal gap size and speech intelligibility (correlation coefficient = −0.6, P <.01). Only the size of the size of the gap is a significant predictor of speech intelligibility after cleft palate repair. Conclusion: There is a significant, moderate correlation between velopharyngeal gap size and speech intelligibility. [ABSTRACT FROM AUTHOR]

Introduction: Vomer flap is a technique to close cleft lip and palate. This technique is a simple procedure that has many benefits. However, the vomer flap's application together with primary lip closure is still questionable. Objective: To find out whether the vomer flap's application in primary cleft lip repair can provide significant benefits Design: A systematic review was conducted using the PRISMA methodology has been licensed in PROSPERO databases (CRD42023399487). Setting: A comprehensive search was set out, utilizing eight data sources up to March 2023. Participants: Both cohort studies and randomized control trials regarding the use of vomer flaps performed concurrently with cleft lip repair in children up to six months old. Results: This article involved 8 studies involving 542 patients who met the inclusion criteria, consisting of 6 retrospective cohort studies, 1 RCT study, and 1 prospective cohort study. Vomer flaps provide a reduction in palatal cleft distance of 3–5 mm, a relatively small number of fistulas (0–4%), improvement of velopharyngeal function (nasal tone and nasal emission), maximal development of the maxilla although it is still controversial. Conclusion: The vomer flap's application in primary cleft lip repair provides many advantages, such as reduced palatal and alveolar clefts, decreased risk of oronasal fistula, increased velopharyngeal function, and increased maxillary growth. It is reliable for the management of cleft lip and palate. [ABSTRACT FROM AUTHOR]

Objective: Identification of patient factors influencing velopharyngeal function for speech following initial cleft palate repair. Design: A literature search of relevant databases from inception until 2018 was performed using medical subject headings and keywords related to cleft palate, palatoplasty and speech assessment. Following three stage screening data extraction was performed. Setting: Systematic review and meta-analysis of relevant literature. Patients/Participants: Three hundred and eighty-three studies met the inclusion criteria, comprising data on 47 658 participants. Interventions: Individuals undergoing initial palatoplasty. Main Outcome Measures: Studies including participants undergoing initial cleft palate repair where the frequency of secondary speech surgery and/or velopharyngeal function for speech was recorded. Results: Patient factors reported included cleft phenotype (95% studies), biological sex (64%), syndrome diagnosis (44%), hearing loss (28%), developmental delay (16%), Robin Sequence (16%) and 22q11.2 microdeletion syndrome (11%). Meta-analysis provided strong evidence that rates of secondary surgery and velopharyngeal dysfunction varied according to cleft phenotype (Veau I best outcomes, Veau IV worst outcomes), Robin Sequence and syndrome diagnosis. There was no evidence that biological sex was associated with worse outcomes. Many studies were poor quality with minimal follow-up. Conclusions: Meta-analysis demonstrated the association of certain patient factors with speech outcome, however the quality of the evidence was low. Uniform, prospective, multi-centre documentation of preoperative characteristics and speech outcomes is required to characterise risk factors for post-palatoplasty velopharyngeal insufficiency for speech. Systematic Review Registration: Registered with PROSPERO CRD42017051624. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of common pediatric orthodontic appliances on velopharyngeal (VP) MRI and to compare MR image sequences to determine if sequence parameters impact the visibility of key VP structures commonly assessed in clinical VP MRI. Design: Participants undergoing orthodontic treatment completed a VP MRI study. Level of distortion caused by orthodontic devices on 8 anatomical sites of interest and using variable MRI sequences was evaluated. Setting: Single institution Participants: Nineteen participants undergoing orthodontic treatment. Main Outcome: Level of distortion caused by metal artifacts and MR sequence used. Results: The results of this study demonstrate that appliances such as hyrax palatal expanders and braces with stainless steel brackets are acceptable for a VP MRI, while class II corrector springs are not recommended. The HASTE MRI sequence with 2D imaging techniques should be utilized if the child has orthodontic devices, while FSE and 3D imaging techniques are not recommended. The presence of wire spring coils and molar bands are likely to not to interfere with the MRI evaluation. Conclusions: Findings from this study suggest that the presence of orthodontic appliances does not hinder visualization of all velopharyngeal structures during an MRI. Therefore, careful consideration must be made prior to disqualifying or recommending patients for VP MRI. [ABSTRACT FROM AUTHOR]

Background: Speech in individuals with cleft lip and/or palate (CLP) is a complex myriad of presenting symptoms. It is uniquely associated with the structural difference of velopharyngeal insufficiency (VPI), together with a wide and heterogeneous range of other aetiologies which often co‐occur. The nature of the speech sound disorder (SSD) including VPI may also change over the course of an individual's care pathway. Differences in terminology and approaches to analysis are currently used, resulting in confusion internationally. Additionally, current diagnostic labels and classification systems in SSD do not capture the complexity and full nature of speech characteristics in CLP. Aims: This paper aims to explore the different aetiologies of cleft palate/VPI speech and to relate aetiology with speech characteristic(s). In so doing, it attempts to unravel the different terminology used in the field, describing commonalities and differences, and identifying overlaps with the speech summary patterns used in the United Kingdom and elsewhere. The paper also aims to explore the applicability of current diagnostic labels and classification systems in the non‐cleft SSD literature and illustrate certain implications for speech intervention in CLP. Methods and Procedures: The different aetiologies were identified from the literature and mapped onto cleft palate/VPI speech characteristics. Different terminology and approaches to analysis are defined and overlaps described. The applicability of current classification systems in SSD is discussed including additional diagnostic labels proposed in the field. Outcomes and Results: Aetiologies of cleft palate/VPI speech identified include developmental (cognitive‐linguistic), middle ear disease and fluctuating hearing loss, altered oral structure, abnormal facial growth, VPI‐structural (abnormal palate muscle) and VPI‐iatrogenic (maxillary advancement surgery). There are four main terminologies used to describe cleft palate/VPI speech: active/passive and compensatory/obligatory, which overlap with the four categories used in the UK speech summary patterns: anterior oral cleft speech characteristics (CSCs), posterior oral CSCs, non‐oral CSCs and passive CSCs, although not directly comparable. Current classification systems in non‐cleft SSD do not sufficiently capture the full nature and complexity of cleft palate/VPI speech. Conclusions and Implications: Our attempt at identifying the heterogeneous range of aetiologies provides clinicians with a better understanding of cleft palate/VPI speech to inform the management pathway and the nature and type of speech intervention required. We hope that the unravelling of the different terminology in relation to the UK speech summary patterns, and those used elsewhere, reduces confusion and provides more clarity for clinicians in the field. Diagnostic labels and classification require international agreement. WHAT THIS PAPER ADDS: What is already known on the subject: Speech associated with cleft palate/velopharyngeal insufficiency (VPI) is a complex myriad of speech characteristics with a wide and heterogeneous range of aetiologies. Different terminology and speech summary patterns are used to describe the speech characteristics. The traditional classification of cleft palate/VPI speech is Articulation Disorder, although evidence is building for Phonological Disorder and contrastive approaches in cleft speech intervention. What this paper adds to existing knowledge: This paper explores the range of aetiologies of cleft palate/VPI speech (e.g., altered oral structure, abnormal facial growth, abnormal palate muscle and iatrogenic aetiologies) and attempts to relate aetiology with speech characteristic(s). An attempt is made at unravelling the different terminology used in relation to a well‐known and validated approach to analysis, used in the United Kingdom and elsewhere. Complexities of current diagnostic labels and classifications in Speech Sound Disorder to describe cleft palate/VPI speech are discussed. What are the potential or actual clinical implications of this work?: There needs to be a common language for describing and summarising cleft palate/VPI speech. Speech summary patterns based on narrow phonetic transcription and correct identification of aetiology are essential for the accurate classification of the speech disorder and identification of speech intervention approaches. There is an urgent need for research to identify the most appropriate type of contrastive (phonological) approach in cleft lip and/or palate. [ABSTRACT FROM AUTHOR]

Objective : Assess agreement of hypernasality and audible nasal emission (ANE) ratings between audio-recordings and a clinic setting. Design/Setting : Cross-sectional study using retrospective clinical recordings. Participants/Intervention : Audio-recording ratings by two trained speech language pathologists. Main Outcome Measures : Percent agreement and intra- and inter-rater reliability of perceptual ratings. Results : Intra-rater reliability (AC2) of 167 audio-recorded speech samples for the primary and secondary raters, respectively, was 0.82 and 0.79 for hypernasality; for ANE, it was 0.57 and 0.75. Inter-rater reliability was 0.77 for hypernasality and 0.63 for ANE. When comparing ratings made from audio-recording versus the original clinical ratings, intra-rater reliability was 0.85 and 0.61 (primary and secondary rater, respectively) for hypernasality and 0.21 and 0.34 for ANE. Conclusions : Ratings for hypernasality made from audio recordings were consistent with clinical evaluation, while ratings of ANE were not. ANE ratings made from audio recordings may not be a valid measure of velopharyngeal insufficiency speech characteristics. [ABSTRACT FROM AUTHOR]

Objective: To introduce a highly innovative imaging method to study the complex velopharyngeal (VP) system and introduce the potential future clinical applications of a VP atlas in cleft care. Design: Four healthy adults participated in a 20-min dynamic magnetic resonance imaging scan that included a high-resolution T2-weighted turbo-spin-echo 3D structural scan and five custom dynamic speech imaging scans. Subjects repeated a variety of phrases when in the scanner as real-time audio was captured. Setting: Multisite institution and clinical setting Participants: Four adult subjects with normal anatomy were recruited for this study. Main Outcome: Establishment of 4-D atlas constructed from dynamic VP MRI data. Results: Three-dimensional dynamic magnetic resonance imaging was successfully used to obtain high quality dynamic speech scans in an adult population. Scans were able to be re-sliced in various imaging planes. Subject-specific MR data were then reconstructed and time-aligned to create a velopharyngeal atlas representing the averaged physiological movements across the four subjects. Conclusions: The current preliminary study examined the feasibility of developing a VP atlas for potential clinical applications in cleft care. Our results indicate excellent potential for the development and use of a VP atlas for assessing VP physiology during speech. [ABSTRACT FROM AUTHOR]

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Objective: Surgical treatment of velopharyngeal insufficiency (VPI) includes a wide array of procedures. The purpose of this study was to develop a classification for VPI procedures and to describe variations in how they are performed. Design/participants/setting/outcomes: We completed an in-depth review of the literature to develop a preliminary schema that encompassed existing VPI procedures. Forty-one cleft surgeons from twelve hospitals across the USA and Canada reviewed the schema and either confirmed that it encompassed all VPI procedures they performed or requested additions. Two surgeons then observed the conduct of the procedures by surgeons at each hospital. Standardized reports were completed with each visit to further explore the literature, refine the schema, and delineate the common and unique aspects of each surgeon's technique. Results: Procedures were divided into three groups: palate-based surgery; pharynx-based surgery; and augmentation. Palate-based operations included straight line mucosal incision with intravelar veloplasty, double-opposing Z-plasty, and palate lengthening with buccal myomucosal flaps. Many surgeons blended maneuvers from these three techniques, so a more descriptive schema was developed classifying the maneuvers employed on the oral mucosa, nasal mucosa, and muscle. Pharynx-based surgery included pharyngeal flap and sphincter pharyngoplasty, with variations in design for each. Augmentation procedures included palate and posterior wall augmentation. Conclusions: A comprehensive schema for VPI procedures was developed incorporating intentional adaptations in technique. There was substantial variation amongst surgeons in how each procedure was performed. The schema may enable more specific evaluations of surgical outcomes and exploration of the mechanisms through which these procedures improve speech. [ABSTRACT FROM AUTHOR]

Objective: To determine whether performing tonsillectomy at the time of Furlow palatoplasty for the treatment of cleft palate related velopharyngeal insufficiency (VPI) incurs increased surgical complications or compromises speech outcomes. Design: A retrospective review of patients who had Furlow palatoplasty and the outcomes of surgery in the treatment of cleft palate related VPI. Setting: A single academic center between January 2015 and January 2022. Participants: Patients with submucous cleft (SMC) palate or patients with prior straight line primary palatoplasty presenting with VPI. Interventions: Simultaneous conversion Furlow palatoplasty and tonsillectomy. Main Outcome Measure(s): Primary outcome measures include preoperative and postoperative Modified Pittsburgh Weighted Speech Scale (mPWSS), and postoperative surgical complications. Results: Eight patients (25%) underwent Furlow palatoplasty and concomitant tonsillectomy, while 24 patients (75%) underwent Furlow palatoplasty alone. A significantly lower median postoperative mPWSS score, corresponding to better velopharyngeal function, was reported for patients in the Furlow-tonsillectomy group (0, IQR 0-0) compared to the Furlow only group (1, IQR 0–9, p = 0.046). No surgical complications were encountered in either group. Five patients (20.8%) in the Furlow only group required subsequent surgery for persistent VPI. No patients in the Furlow-tonsillectomy group required additional surgical treatment for VPI (0%, p = 0.16). Conclusions: Tonsillectomy at time of Furlow palatoplasty is utilized in patients with both VPI and baseline tonsillar hypertrophy to lessen the risk of postoperative obstructive breathing. Tonsillectomy performed concurrently with Furlow palatoplasty is safe, without increased risk of surgical complications, and does not compromise post-Furlow palatoplasty speech outcomes [ABSTRACT FROM AUTHOR]

Background: This study aims to determine a generalized outcome and risk profile for patients undergoing orthognathic surgery for the definitive treatment of cleft lip and palate. Furthermore, we hope to determine the key risk factors that cause increased risk for cleft lip and palate patients undergoing orthognathic surgery. Methods: This study includes a systematic review using PubMed, MEDLINE, Cochrane, and Scopus. Data curation utilized Covidence software, with dual-reviewer screening and conflict resolution by a third party, focusing on publications with the full texts available. Results: The initial search yielded 1697 articles. Following title, abstract, and full-text screening, a total of 62 articles were included in this review. A total of 70.9% of included articles had moderate bias, with the rest having low risk of bias. The sample consisted of 2550 patients with an average age of about 20 years and an average follow-up of 16.8 months. The most employed procedure was Le Fort I osteotomy (99%). In terms of velopharyngeal function, there were notable increases in insufficiency and severity scores, with an average 63% worsening score from the baseline. That being said, patients experienced an average 33% improvement in speech articulation. Furthermore, the average horizontal movement was reported to be 6.09 mm with a subsequent relapse of 0.98 mm overall. Conclusions: This systematic review distills data from 62 articles and 2550 patients. It highlights the efficacy of orthognathic surgery in addressing oropharyngeal and aesthetic deficits. This study identifies relapse and velopharyngeal insufficiency as recurrent complications. These insights inform surgical refinement and patient counseling, laying a foundation for enhanced clinical protocols. [ABSTRACT FROM AUTHOR]

Background: Identification of borderline cases of velopharyngeal insufficiency (VPI) due to palatopharyngeal disproportion in the form of short palate or deep posterior pharyngeal wall is necessary particularly in preoperative assessment of adenotonsillectomy to prevent post-adenotonsillectomy velopharyngeal insufficiency and hypernasality. Objective: To evaluate the role of fiberoptic nasopharyngoscopy and cephalometry for assessment of clinically suspected cases of palatopharyngeal disproportion (borderline VPI) cases to identify the craniofacial morphometric measurements of such cases that may be helpful as a prognostic indicator in predicting and preventing post-adenotonsillectomy velopharyngeal dysfunction. Design: This is an observational cross-sectional study of 38 patients with suspected palatopharyngeal disproportion (24 male and 14 female) with ages ranging from 3 to 7 years who were referred to the phoniatrics unit at Assiut University Hospital for the assessment of the velopharyngeal valve before adenotonsillectomy operation. The control group consisted of 25 normal individuals. They were subjected to (1) auditory perceptual assessment (APA) of the patients' speech, (2) fiberoptic nasopharyngoscopy, and (3) lateral cephalometry. Results: Auditory perceptual assessment showed no statistically significant difference between both groups. Fiberoptic nasopharyngoscopic examination revealed a highly significant statistical difference between both groups as regards lateral pharyngeal wall mobility (p = 0.000). Lateral cephalometric assessment showed significant statistical differences for maxillary protrusion (P = 0.04) which was slightly wider in the study group than in the control group and bony pharyngeal depth (Ptm-Ba) (P = 0.03) which was deeper in the study group than in the control group. Conclusion: Auditory perceptual assessment of speech, nasopharyngoscopy, and cephalometry are important tools that could be used for pre-adenotonsillectomy assessment of cases with palatopharyngeal disproportion to prevent the post-adenotonsillectomy velopharyngeal insufficiency and its consequences. [ABSTRACT FROM AUTHOR]

Objective.: A new critical complication risk analysis, the reasonable risk ratio (RRR or R3) for palate surgeries in obstructive sleep apnea patients. Methods.: Analysis from published meta-analyses, systematic reviews on success rates, and complications encountered for 3 palate surgeries, expansion sphincter pharyngoplasty (ESP), barbed repositioning pharyngoplasty (BRP) and modified uvulopalatopharyngoplasty (mUPPP), over 20 years. The RRR is derived from a ratio of the percentage of each respective complication over the success rate of that particular surgical procedure. The benchmark RRR of tonsillectomy is set at 0.035 to 0.078. An RRR below this benchmark value is more favorable as tonsillectomy is a widely accepted ENT procedure with risks to benefit well accepted. Results.: The RRR for foreign body (FB) sensation (BRP) ranged from 0.03 to 0.23 (mean RRR of 0.14), FB sensation (ESP) 0.01, FB sensation (mUPPP) ranged from 0.33 to 0.55 (mean RRR of 0.44). The RRR for swallowing difficulties (BRP) ranged from 0.04 to 0.23 (mean RRR of 0.11), mUPPP, was 0.37; no reported swallowing difficulties with the ESP. The RRR for velopharyngeal insufficiency (VPI) (BRP) ranged from 0.009 to 0.18 (mean RRR of 0.07), and RRR VPI (mUPPP) was 0.14. The RRR (BRP) for dry throat was 0.06 and the mUPPP was 0.35, with no reported VPI or dry throat for ESP. The overall RRR for the BRP was 0.09, ESP was 0.01 and mUPPP was 0.29. Conclusion.: RRR provides a summarized data-driven, statistical guide to aid decision-making, and helps in patient counseling. BRP and ESP have been shown to have less complications compared to mUPPP. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Objectives: This study conducts a comparative analysis of the temporal facets of velopharyngeal coarticulation in Persian-speaking adults, differentiating between subjects with and without cleft palate, across three distinct vowel contexts. Methods: The study included 14 adults who had undergone cleft palate repair, with or without cleft lip and presented moderate to severe hypernasality. Another 14 adults without cleft palate were included in the study. The age range of participants was 18 to 50 years. By utilizing the Praat software, version 6.1.50, the study obtained data for the four temporal parameters by analyzing acoustic waveforms and spectrograms within three distinct vowel contexts. The analysis included the calculation of ratios of nasalization duration to neutralize the influence of speech rate variations between the cleft palate and control groups. Results: The results revealed that adults with cleft palate exhibited significantly extended durations for the four temporal parameters compared to the control group (P<0.001). Discussion: The findings underscore that adults with cleft palate demonstrate prolonged nasalization durations in their speech, signifying potential temporal disparities in velopharyngeal coarticulation. This divergence is most evident in the context of the/i/vowel. The temporal aspects of nasalization, denoting the temporal dimensions of the acoustic impedance related to the oral and nasal cavities, can potentially impact the hypernasality perception in adults with cleft palate. This study proposed that an acoustic examination of speech's temporal aspects can effectively quantify the degree of nasalization in cleft palate individuals and a control group. Furthermore, the results indicate that the development of motor speech control significantly contributes to the mechanisms underpinning anticipatory and carryover velopharyngeal coarticulation. [ABSTRACT FROM AUTHOR]

Background: Velopharyngeal dysfunction (VPD) in head and neck cancer is frequently clinically reported, affecting both speech and swallowing function. This review sought to identify the tumor subsites and treatment modalities reported in association with VPD and summarize the current reporting methodology of VPD-related speech and swallowing outcomes in patients following head and neck cancer treatment. Methods: A literature search was conducted through December 2020 using electronic databases and a total of 15 studies were included in review. Results: Reported VPD was largely secondary to palate resections. Large variability in reporting methodology was noted with heavy reliance on speech-related perceptual measures and swallowing-related patient-reported outcomes over imaging and instrumental evaluations. Conclusions: This review revealed inconsistencies in evaluating and reporting VPD, which likely translates into inconsistencies in clinical management. Further attention to VPD secondary to other head and neck malignancies would provide a broader perspective on VPD through head and neck cancer treatment. [ABSTRACT FROM AUTHOR]

Purpose: To objectively evaluate the effect of maxillary advancement on speech and VPI using video-fluoroscopy (VFS), direct nasoendoscopy, and speech evaluation and subjectively assess patients and their peer's perception regarding their speech outcome. Materials and methods: 27 cleft patients who underwent Lefort 1 maxillary advancement were divided into 2 groups- Group A with 4-7 mm of advancement and Group B with 8-13 mm advancement. VFS in lateral view, nasoendoscopy, and speech recordings were performed pre and 6 months postoperatively. VFS assessed the relative position of velum in relation to the pharyngeal wall, speech was evaluated for changes in nasal emission, resonance, and articulation along with nasal endoscopy to assess the overall function of the velopharyngeal valve. Subjective speech evaluation was done with a Patient-Reported Outcome Measure [PROM] questionnaire. Results: As per VFS, for every 1 mm maxillary advancement, the velopharyngeal gap at rest increased by 1.75 mm in group A and 1.58 mm in group B. The compensatory changes in group B were more pronounced. Post-operative VFS showed velar closure remained the same as preoperative closure in 86.7%, and worsened in 13.3% in group A whereas it remained unchanged in 66.7%, improved in 25%, and worsened in 8.3% in group B. In nasoendoscopy, the closure pattern showed no change in 86.6%, improved in 6.7%, and deteriorated in 8.3% in group A while there was no change in 83.4%, improved in 8.3%, and deteriorated in 8.3% in group B. Dental and labiodental articulation statistically improved [p < 0.05] after surgery. PROM reported 85.7% of patients with improved speech, 82.1% improved sound quality along with 89.3% improvement in articulation. Conclusion: The primary cause for functional impairment and poor aesthetics in cleft deformity is the maxillary hypoplasia and therefore, should be the focus during correction. The pre-operative VP status or the amount of maxillary advancement could not predict the postoperative VP status. Maxillary advancement over 10 mm did not seem to significantly affect the final VP status. Articulation improves due to increased tongue space and favorable dental segment positioning. Mild to moderate immediate post op changes in nasality improves or even reverts to their preoperative status in the majority of the cases in about six months. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the relationship between perceptual ratings of hypernasality made during connected speech and velopharyngeal (VP) gap size measured in millimeters in the sagittal plane during sustained vowel production using magnetic resonance imaging (MRI). Method: A retrospective cross-sectional analysis was completed. A subgroup of 110 participants from another study with an Mage of 10.1 years presenting for management of VP insufficiency was included. Perceptual ratings of hypernasality during connected speech and measurement of gap size during sustained /i/ production on MRI were performed by raters blinded to the participants' medical and surgical history. Results: There was a moderate-to-strong, positive correlation (r = .61; p < .001) between hypernasality ratings and VP gap size measured on MRI using sustained /i/. The odds of a higher hypernasality rating increased as the gap size increased (odds ratio = 1.34; 95% CI [1.20, 1.49]; p < .001). The predicted probability for hypernasality ratings of none/minimal/mild steadily decreased as the gap size increased indicating that lower ratings of hypernasality were associated with smaller gap sizes. For the rating of "moderate" hypernasality, the predicted probability of the rating steadily increased up to 8 mm and then decreased as the gap size continued to increase. The predicted probability for a hypernasality rating of "severe" consistently increased as the gap size increased. Conclusions: Hypernasality ratings made at the connected speech level were significantly associated with VP gap size as measured during sustained vowel production. These findings suggest sustained vowel production elicited on MRI may adequately characterize VP gap size in the evaluation of VP insufficiency. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a method of measuring the change in palatal length and shape following maxillary advancement using synchronous lateral videofluoroscopy and voice recording in order to understand how movement of the maxilla may affect VPI risk in patients with cleft lip and/or palate (CL/P). Design: Retrospective cohort study of children with cleft lip and/or palate. Setting: Single center, tertiary children's hospital. Participants: Patients with cleft lip and/or palate who underwent maxillary advancement between 2016–21 inclusive. Interventions: Maxillary advancement surgery, including those who underwent concurrent mandibular procedures. Main outcome measures: The length of the soft palate and the genu angle were measured throughout palatal dynamic range. Pre- and post-operative measurements were compared using a one sided T-test, with subgroup analysis for patients with clinical VPI. Results: Ten patients were examined. The mean distance of maxillary advancement was 10.5 mm. The average increase in pre-genu soft palate length was 2.8 mm in the resting position and 2.9 mm in the closed position. The genu angle decreased in the closed position by 16.3 degrees. Conclusions: The soft palate showed limited ability to lengthen following maxillary advancement and this may explain the risk of VPI. There was partial compensation by the muscle sling of the palate as demonstrated by a more acute post-operative genu angle and this suggests one reason for the variability of VPI reported. Future research is required to investigate how length and shape changes measured using this method can predict VPI risk. [ABSTRACT FROM AUTHOR]

Objective: The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution. Design: Retrospective cohort study. Setting: Tertiary children's hospital. Patients: Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017. Outcome measures: We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA). Results: 160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p = 0.037) and more likely to have cleft palate (63/119 vs 14/41; p = 0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p = 0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p = 0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p = 0.032). PSA scores were found to be lower (less hypernasal) after PFU (p = 0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p = 0.001), while PFT (p = 0.525) did not demonstrate a statistical difference. Conclusion: The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications. [ABSTRACT FROM AUTHOR]

This clinical report describes the implementation of magnetic resonance imaging (MRI) to evaluate a patient with long-standing velopharyngeal dysfunction. She was referred to the craniofacial clinic at age 10 with no prior surgical history and subsequently completed a Furlow palatoplasty due to a suspected submucous cleft palate. However, results were unfavorable with minimal improvement in speech or resonance. The clinical presentation, treatment, outcomes, and contributions from MRI for secondary surgical planning are described. Addition of MRI into the clinical workflow provided insights into the anatomy and physiology of the velopharyngeal mechanism that were unable to be obtained from nasendoscopy and speech evaluation alone. [ABSTRACT FROM AUTHOR]

Objective This study aimed to review literature from the past five years, focusing on the use of educational videos as a guidance tool for parents and guardians of children with lip and palate clefts. Source of data Conducted between April and July 2022, this integrative literature review was framed around the question: 'What is the evidence regarding the use of videos in health education for parents/guardians of children with cleft lip and palate? PICO strategy was used to develop the research. A literature search was undertaken across PubMed, Web of Science, Scopus, and the Virtual Health Library databases. Of the eight articles included in this review, four were sourced from the PubMed database, with three published in 2021. Summary of the findings The findings indicated that YouTube videos were moderately satisfactory and met the needs of parents or legal guardians to a partial extent. The majority of the videos analyzed in this review were characterized by a moderate level of informational content. One study particularly underscored that the content of these videos only partially satisfies the requirements of the parents or legal guardians of the children. Conclusions Nevertheless, such videos are considered viable alternatives for health education, offering numerous benefits yet facing challenges, primarily due to the scarcity of information on orofacial malformations. [ABSTRACT FROM AUTHOR]

Objectives: After cleft lip and/or palate (CL/P) repair, children may develop velopharyngeal insufficiency (VPI) leading to speech imperfections, necessitating additional speech correcting surgery. This study examines the incidence of VPI and speech correcting surgery after Sommerlad’s palatoplasty for CL/P, and its association with various clinical features. Materials and methods: A retrospective cohort study was performed in the Wilhelmina Children’s Hospital in Utrecht and child records from 380 individuals with CL/P registered from 2008 to 2017 were retrospectively reviewed. Inclusion criteria comprised the diagnosis of CL/P, primary palatoplasty according to Sommerlad’s technique, and speech assessment at five years or older. Association between cleft type and width, presence of additional genetic disorders and postoperative complications (palatal dehiscence, fistula) were assessed using odds ratios and chi squared tests. Results: A total of 239 patients were included. The VPI rate was 52.7% (n = 126) and in 119 patients (49.8%) a speech correcting surgery was performed. Severe cleft type, as indicated by a higher Veau classification, was associated with a significant higher rate of speech correcting surgeries (p = 0.033). Significantly more speech correcting surgeries were performed in patients with a cleft width >10 mm, compared to patients with a cleft width ≤10 mm (p < 0.001). Patients with oronasal fistula underwent significantly more speech correcting surgeries than those without fistula (p = 0.004). No statistically significant difference was found in the incidence of speech correcting surgery between patients with and without genetic disorders (p = 0.890). Conclusions/clinical relevance: Variations in cleft morphology, cleft width and complications like oronasal fistula are associated with different speech outcomes. Future research should focus on creating a multivariable prediction model for speech correcting surgery in CL/P patients. [ABSTRACT FROM AUTHOR]

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Introduction: Superiorly based pharyngeal flap is one of the most common surgical techniques described for surgical correction of velopharyngeal disorders. Being a technique-sensitive and owing to its associated complications, a simple technique has been introduced and compared with it. Aim: The aim was to compare the surgical results and the phoniatric outcome of the superiorly based pharyngeal flap versus the myomucosal resection and direct closure of the posterior pharyngeal wall. Patients and Method: One hundred patients of both sexes were classified into two groups. Group A patients included fifty patients who had velopharyngeal insufficiency (VPI) and were surgically corrected by the superiorly based pharyngeal flap. Group B patients included fifty patients who had VPI and were surgically corrected by myomucosal resection and direct closure of the posterior pharyngeal wall. Results: Postoperatively, 13% of Group A patients had open nasality Grade 4 as compared to 0% in Group B patients. Hyponasality and obstructive sleep apnea were not recorded in any case of Group B patients as compared with 10% of Group A patients. With regard to the postoperative velopharyngeal gap during speech, 18% of patients in Group A had velopharyngeal gap 3 mm, while 10% of patients in Group B had velopharyngeal gap 3 mm. Conclusion: Myomucosal resection and direct closure of the posterior pharyngeal wall is a simple reliable technique for the correction of velopharyngeal disorders. [ABSTRACT FROM AUTHOR]

Background: The pharyngeal flap (PF) is useful for reconstruction of soft palate defects, but effective arrangements of PF for various types of soft palate defects are controversial. Here, we classify three types of soft palate defects and discuss the arrangements of PF and their functional prognosis. Methods: Reconstruction was performed based on the classification of the defects. Clinical details were collected, and postoperative function was analyzed. Results: Eight patients were included in the study. The defect sizes ranged from 25 (width) × 40 (depth) to 40 × 60 mm. Six patients underwent pharyngeal flap reconstruction with free‐flap reconstruction, and two underwent pharyngeal flap reconstruction. The pharyngeal flap was harvested at the maximum width of the posterior pharyngeal wall, ranging from 25 to 40 mm in length. Eating and speaking functions were maintained in all patients. Conclusions: Good postoperative function can be maintained by narrowing the velopharyngeal space with a pharyngeal flap. [ABSTRACT FROM AUTHOR]

Objective : To determine the sensitivity and specificity of velar notching seen on nasopharyngoscopy for levator veli palatini (LVP) muscle discontinuity and anterior positioning. Design : Nasopharyngoscopy and MRI of the velopharynx were performed on patients with VPI as part of their routine clinical care. Two speech-language pathologists independently evaluated nasopharyngoscopy studies for the presence or absence of velar notching. MRI was used to evaluate LVP muscle cohesiveness and position relative to the posterior hard palate. To determine the accuracy of velar notching for detecting LVP muscle discontinuity, sensitivity, specificity, and positive predictive value (PPV) were calculated. Setting : A craniofacial clinic at a large metropolitan hospital. Participants: Thirty-seven patients who presented with hypernasality and/or audible nasal emission on speech evaluation and completed nasopharyngoscopy and velopharyngeal MRI study as part of their preoperative clinical evaluation. Results : Among patients with partial or total LVP dehiscence on MRI, presence of a notch accurately identified discontinuity in the LVP 43% (95% CI 22-66%) of the time. In contrast, the absence of a notch accurately indicated LVP continuity 81% (95% CI 54-96%) of the time. The PPV for the presence of notching to identify a discontinuous LVP was 78% (95% CI 49-91%). The distance from the posterior edge of the hard palate to the LVP, known as effective velar length, was similar in patients with and without notching (median 9.8 mm vs 10.5 mm, P = 1.00). Conclusion : The observation of a velar notch on nasopharyngoscopy is not an accurate predictor of LVP muscle dehiscence or anterior positioning. [ABSTRACT FROM AUTHOR]

Objective: To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair. Methods: This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate. Results: A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n = 16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects. Conclusion: The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to develop a sonographic technique using two-dimensional (2D) markers for detecting isolated fetal cleft palate (no cleft lip) and to evaluate the ability of 2D and three-dimensional (3D) sonography to image the normal and abnormal palate. Methods: Seventy-three fetuses with a high risk of cleft palate at 12-39 weeks of gestation were referred for specialist ultrasound. A detailed evaluation of the palate was performed through 2D ultrasound, which revealed the appearance of the palatine line in the sagittal plane; the palate and alveolar ridge in the coronal plane of the fetal face; the horizontal plate of the palatine bone in the axial maxillary plane; and the soft palate in the transverse plane of the cavum pharyngis. Subsequently, 3D ultrasound imaging of the palate was performed in all fetuses. Antenatal diagnoses were compared with postnatal findings or autopsy findings. Results: Visualization of 2D markers was accomplished in all fetuses, and 3D assessment was achieved in 97% of fetuses. Cleft palate was suspected in 16 cases (21.9%), among which 14 were suspected on the basis of both 2D and 3D evaluation, and two were suspected only on the basis of 3D evaluation. A normal palate was observed in 57 fetuses (78.1%). The mean gestational age was 27 weeks (range of 12 weeks to 39 weeks). All 16 fetuses with suspected cleft palate were confirmed by postnatal or autopsy findings, no false-positives were observed, and one case with a bifid uvula was missed among 57 fetuses with a presumed normal palate. Conclusions: The fetal palate can be evaluated with 2D markers and 3D sonography. The detection of isolated cleft palate is more sensitive when 2D markers are present in all four planes. [ABSTRACT FROM AUTHOR]

Objectives: We aim to verify velopharyngeal sphincter function in 22q11.2 deletion syndrome patients (22q11.2DS) to establish correlations between aerodynamic and perceptual measures of nasality, and to identify aerodynamic measures differentiating typical from atypical velopharyngeal behavior. Methods: Eleven subjects with 22q11.2DS and twenty similar-age control subjects were recruited. The aerodynamic measures were mean Sound Pressure Level, air pressure peak, pressure wave duration, airflow pattern and nasal airflow during the sequence /pi/. The nasality perceptual measures were rhinolalia, rhinophony and nasal air escape. Results: Airflow patterns and perceptual measures were statistically different in the two groups. Pressure wave duration and air pressure peak were lower in study subjects than in controls. Air pressure peak and nasal airflow were negatively correlated with rhinolalia; pressure wave duration was negatively correlated with nasal air escape and rhinolalia in 22q11.2DS patients. Conclusions: This aerodynamic study identified velopharyngeal qualitative and quantitative dysfunctions, suggesting heterogeneous models of velopharyngeal function in syndromic subjects as compared to controls. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with cleft lip and/or palate (CL/P) are at an increased risk of developing emotional disorders. This study aims to explore this question in greater depth by addressing three objectives: (1) the presence of neuroticism as an indicator of emotional symptomatology, (2) the use of adaptive and non-adaptive emotional regulation strategies, and (3) the relationship between these strategies and neuroticism. Methods: A case–control correlational methodology was employed, with 60 children and adolescents with CL/P (mean age = 12.80 years; 33 females) and 60 non-clinical equivalent children and adolescents. Results: The CL/P group has higher scores on neuroticism (t = −7.74; p ≤ 0.001, d Cohen = 1.43) and lower scores in almost all emotional regulation strategies. The presence of CL/P moderated the relationship between neuroticism and self-blame (Beta = −0.46, t = −2.81, p = 0.005), rumination (Beta = −0.49, t = −3.73, p < 0.001), catastrophizing (Beta = −0.61, t = −4.26, p < 0.001), and blaming others (Beta = −0.45, t = −2.84, p = 0.005). This model predicted a significant variance of neuroticism (all p < 0.005), which ranged from 39% to 41%. Conclusions: The CL/P group has worse mental health indicators. Particularly novel results about the CL/P group are the lower scores on regulation strategies (both adaptive and non-adaptive) and the fact that non-adaptive strategies contribute, contrary to their effect in the general population, to a decrease in neuroticism. It supports the need to incorporate mental health indicators in the diagnosis and treatment of children and adolescents with CL/P. [ABSTRACT FROM AUTHOR]

Surgical intervention can contribute to the development of velopharyngeal insufficiency (VPI) leading to hypernasality and regurgitation. In this case, a patient with a history of bilateral buccal flaps used for her primary CP repair presented to clinic with hypernasality and VPI as assessed by speech exam and imaging. She underwent repeat bilateral buccal flap palatal lengthening with division of the pedicles 3 months later. Three months after her division, her hypernasality score improved from moderate to mild and her posterior gap decreased. This study concluded buccal flaps can be used a second time for patients needing palatal revisions for VPI. [ABSTRACT FROM AUTHOR]

Objective: This study investigates whether the use of acellular dermal matrix (ADM) affects the long-term speech outcomes in patients undergoing primary palatoplasty with radical intravelar veloplasty. Design: Retrospective cohort study. Setting: Tertiary university-affiliated hospital. Participants: A consecutive cohort of 112 patients who underwent primary palatoplasty with radical intravelar veloplasty from August 2014 to March 2018 were included. Main outcome measures: A 2 × 2 cm-sized ADM was incorporated as an interpositional graft between the oral and nasal lining at the soft-hard palate junction. The perceptual analysis of hypernasality and articulation was performed when the age of the patient reached at least 36 months. Cleft-related characteristics and surgical factors affecting the speech outcomes were investigated. Results: The ADM was applied in 57 patients with a mean follow-up of45.76 months (SD, 10.69), while no ADM was used in 55 patients with a mean follow-up of 48.43 months (SD, 14.98). Regarding the hypernasality outcome, 33.3% (19 of 57 patients) of the ADM group and 27.3% (15 of 55 patients) of the control group showed a greater than mild-to-moderate degree. The distribution of hypernasality and articulation grade showed no significant difference between the two groups. After controlling for potential risk factors that may affect the speech outcomes, the use of ADM showed no significant relationship with velopharyngeal insufficiency. Conclusion: The use of ADM use in primary palatoplasty with radical intravelar veloplasty is not associated with the alteration of speech function in early childhood. [ABSTRACT FROM AUTHOR]

Objective: Approximately 30% of patients with a history of repaired cleft palate (CP) go on to suffer from velopharyngeal dysfunction (VPD). This study discusses the operative management of VPD and postoperative speech outcomes in a cohort of CP patients. Setting: An academic tertiary pediatric care center. Methods: Retrospective cohort study. Patients: Patients with history of repaired CP (Veau I-IV) who underwent operative management of VPD between January 1st, 2010 and December 31st, 2020. Operative modalities were posterior pharyngeal flap (PPF), sphincter pharyngoplasty (SPP), Furlow palate re-repair, and buccal myomucosal flap palate lengthening (PL). Outcome measures: The primary outcome measure is postoperative speech improvement evaluated by the Pittsburgh Weighted Speech Scale (PWSS). Results: 97 patients met inclusion criteria. 38 patients with previous straight-line primary palatoplasty underwent Furlow re-repair; these patients were significantly younger (7.62 vs 11.14, P <.001) and were more likely to have severe VPD per PWSS (OR 4.28, P <.01, 95% CI 1.46-12.56) when compared to VPD patients with previous Furlow repair. 21.1% of these patients required an additional non-revisional VPD procedure. The remaining patients underwent a non-revision procedure (26 PPF, 22 SPP, 11 PL); all experienced significant (P <.001 on paired t-test) reductions in PWSS total and subgroup VPD severity scores without difference in improvement between operation types. SPP was statistically associated with all-cause complication (OR 2.79, 95% CI 1.03-7.59, P <.05) and hyponasality (OR 3.27, 95% CI 1.112-9.630, P <.05). Conclusion: Furlow re-repair reduced need for additional VPD operations. Speech outcomes between non-revisional operations are comparable, but increased complications were seen in SPP. [ABSTRACT FROM AUTHOR]

Objective: To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. Design: Methodological study. Participants and Methods: Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. Results: There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. Conclusion: Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice. [ABSTRACT FROM AUTHOR]

Unique anatomical deviations in canal structure are rare in anterior teeth, especially central incisors, and thus risk being overlooked. For successful intervention, a meticulous diagnostic procedure and treatment plan, significantly aided by cone-beam computed tomography (CBCT), are crucial. The case at hand explores the management of a maxillary left central incisor in a cleft palate patient, characterized by multiple developmental lobes, a bulbous crown, and an atypical root anatomy. The primary symptom was pain, accompanied by a history of trauma at age 8 years and ensuing tooth discoloration. Initial evaluations, augmented by CBCT, revealed pulpal necrosis in a single-rooted tooth with three distinct canals. Initial clinical examination was supplemented by electrical pulp testing, RadioVisioGraphy (RVG), and CBCT, after which the root canal therapy was initiated. Informed consent was obtained from the patient. The access cavity preparation resulted in a three-orifice cavity. Subsequently, the canals were enlarged and sufficiently debrided. Calcium-hydroxide was applied for 2 weeks before the commencement of apexification and obturation, followed by esthetic rehabilitation. This case highlights the importance of recognizing rare anatomical variations in anterior teeth and demonstrates the invaluable role of CBCT in both diagnosing and managing such complexities. [ABSTRACT FROM AUTHOR]

Regardless of the underlying cause for speech impairment in speakers with cleft palate, a universal consequence of cleft palate is reduced speech intelligibility. Still, there is no standardised approach for measuring intelligibility for speakers with cleft speech. The current study aimed to determine the relationship between orthographic transcription (OT)-based measures, interval-scale ratings, and visual analog scale (VAS) ratings for perceptual judgements of intelligibility in speakers with cleft palate as judged by speech-language pathologists (SLPs). The speaker participants were six speakers with velopharyngeal insufficiency secondary to cleft palate. Four sets of sentences from the Hearing in Noise Test were recorded from each speaker. A total of 14 SLPs provided their intelligibility judgement on these speaker's recordings by word-by-word orthographic transcriptions, a visual analog scale (0–100), and a 5-point interval rating scale. A Spearman rank correlation test indicated a negative, strong correlation between OT-based measurements and VAS scores (r = −.94; p = 0.01) and between OT-based measurements and interval rating scores (r = −.77, p = 0.01). A strong, positive correlation was found between scores obtained from VAS and interval rating scales (r =.83, p = 0.05). The strong relationship between the objective measure of intelligibility (i.e. OT-based measure) and a subjective measure of intelligibility (i.e. VAS and interval scale) supports using a less time-consuming VAS as a substitute for orthographic transcription in measuring intelligibility in cleft palate speech. [ABSTRACT FROM AUTHOR]

Background: Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV‐mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes. Methods: This retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated. Results: Fifty‐five patients were included. Mean and median follow‐up was 34 months. 98% of patients were AJCC stage I/II. Recurrence‐free survival was 96% with no local recurrences. Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p < 0.001). Multivariate analysis showed sacrifice of the palatal attachments remained a significant risk for VPI (p = 0.009). Conclusion: Loss of soft palate pharyngeal attachments is an independent risk factor for VPI. When oncologically appropriate, the palatal attachments to the pharynx may be preserved. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. Design: Multi-institution, retrospective review of Smile Train Express database. Setting: 1110 Smile Train partner hospitals. Patients/Participants: 2560 patients. Interventions: N/A. Main Outcome Measure(s): Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery Results: The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. Conclusions: Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care. [ABSTRACT FROM AUTHOR]

Objective: To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI) Design: Prospective observational multicenter study Setting: Twelve hospitals across the United States and Canada Participants: Individuals who are 3–23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants Interventions: Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team Main Outcome Measure(s): The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings. Results: Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter. Conclusions: Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date. [ABSTRACT FROM AUTHOR]

Objectives: to audit the surgical management of infants born with non-syndromic cleft lip and palate (CLP) at an Australian cleft unit in a large tertiary paediatric hospital Design: Retrospective cohort study. Setting: A tertiary Cleft centre. Patients: 193 infants born with non-syndromic CLP were referred to the centre and underwent primary repair of their CLP between 2009 and 2020. Main Outcome Measures: (1) The timing and surgical repairs performed; (2) the frequency of postoperative complications; (3) the frequency of secondary Cleft surgery; and (4) the total Cleft-related operations performed for infants born with CLP. Results: Four different surgical repair techniques were performed by six surgeons, and postoperative complications were uncommon (n = 14). Rates of oronasal fistula surgery (10.5% at five years of age; 14.3% at eight years of age) and velopharyngeal insufficiency surgery (8.7% at five years of age; 14.3% at eight years of age) were not significantly different across the surgical repair groups (p-value >0.05) and were comparable to international Cleft centres. Children underwent an average of four operative procedures in this audit period, including primary Cleft repair, ear, nose and throat surgery, and dental care. Surgery for managing Eustachian tube dysfunction was the most common surgical intervention following primary Cleft repair. Conclusions: Children born with non-syndromic CLP have a high early operative burden, with outcomes similar across the spectrum of techniques and surgeons. [ABSTRACT FROM AUTHOR]

Aarskog–Scott syndrome (AAS), also known as facio-digito-genital syndrome, is a rare heterogenous syndrome characterized by facial dysmorphism, brachydactyly, and genetic abnormalities. Although severe craniofacial abnormalities have been reported in AAS, little is known about speech and resonance issues in AAS. Specifically, published data to date have only indicated reports of hypernasality associated with a cleft palate in AAS. This case report provides clinical and anatomic information surrounding hypernasal speech in the absence of an overt cleft palate in a patient with AAS. [ABSTRACT FROM AUTHOR]

Traditional imaging modalities used to assess velopharyngeal insufficiency (VPI) do not allow for direct visualization of underlying velopharyngeal (VP) structures and musculature which could impact surgical planning. This limitation can be overcome via structural magnetic resonance imaging (MRI), the only current imaging tool that provides direct visualization of salient VP structures. MRI has been used extensively in research; however, it has had limited clinical use. Factors that restrict clinical use of VP MRI include limited access to optimized VP MRI protocols and uncertainty regarding how to interpret VP MRI findings. The purpose of this paper is to outline a framework for establishing a novel VP MRI scan protocol and to detail the process of interpreting scans of the velopharynx at rest and during speech tasks. Additionally, this paper includes common scan parameters needed to allow for visualization of velopharynx and techniques for the elicitation of speech during scans. [ABSTRACT FROM AUTHOR]

Objectives: The main purpose of this study was evaluation of the effectiveness of secondary furlow palatoplasty with buccal myomucosal flap (FPBF) for the treatment of velopharyngeal insufficiency (VPI) in patients with a cleft palate who were treated with two flap palatoplasty (TFP) in their primary palate repair. Material and methods: Twenty-three medically free children aged 4–8 years with non-syndromic and previously repaired cleft palate via TFP participated in the study. All patients received secondary surgery following the technique of FPBF. Preoperative speech evaluation was done before the secondary repair and 3 months after the surgery using a hypernasal speech scale, speech intelligibility scale, and nasopharyngoscopy. Results: A statistically significant improvement was observed regarding the degree of hypernasality and speech intelligibility while comparing the preoperative scores after the primary surgery to the postoperative scores after the secondary surgery. In addition, a statistically significant improvement was found in the nasopharyngoscopic assessment. Conclusions: The incorporation of a buccal myomucosal flap with Furlow palatoplasty was successful in improving hypernasality, speech intelligibility, and nasopharyngoscopic scores in patients with cleft palate. Trial registration: clinicaltrials.gov (NCT05626933). Clinical relevance: This technique might be the surgical technique of choice while treating patients who are suffering from VPI after cleft palate repair. [ABSTRACT FROM AUTHOR]

Background Velopharyngeal insufficiency (VPI) is a major complication of cleft palate repair. The purpose of this study was to evaluate the incidence and predictive factors of VPI after cleft palate repair based on 27 years of one surgeon's experience. Methods Medical records were retrospectively reviewed for 652 patients who underwent cleft palate repair between 1995 and 2021. After exclusion of those with other syndromes or developmental disorders, the study included 374 patients with sufficient follow-up until the age of 4 years, when language evaluation was possible. VPI status was categorized through subjective and objective tests into normal, VPI, and borderline. We analyzed potential differences in VPI incidence by multiple factors. Factors with significance were analyzed to confirm the relationships between subvariables. Results Of the 374 patients, 311 (83.2%) exhibited normal pronunciation, 51 (13.6%) had VPI, and 12 (3.2%) were borderline. Primary cleft palate repair performed after 18 months was associated with a higher incidence of VPI than repair conducted before 18 months (p = 0.005). The incidence of VPI was higher in cases of submucous cleft palate than in the other types based on the Veau classification (p = 0.011). However, in the multivariable analysis, only the submucous type showed statistically significant results (p = 0.026). Conclusion A total of 374 people underwent primary cleft palate repair, and 13.6% of those with VPI required secondary therapy. The incidence of VPI was relatively high among patients with primary cleft palate repair after 18 months and patients with submucous cleft palate. [ABSTRACT FROM AUTHOR]