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Objectives: Competent velopharyngeal (VP) function is the basis for normal speech. Understanding how VP structure influences the airflow during speech details is essential to the surgical improvement of pharyngoplasty. In this study, we aimed to illuminate the airflow features corresponding to various VP closure states using computed dynamic simulations., Methods: Three-dimensional models of the upper airways were established based on computed tomography of 8 volunteers. The velopharyngeal port was simulated by a cylinder. Computational fluid dynamics simulations were applied to illustrate the correlation between the VP port size and the airflow parameters, including the flow velocity, pressure in the velopharyngeal port, as well as the pressure in oral and nasal cavity., Results: The airflow dynamics at the velopharynx were maintained in the same velopharyngeal pattern as the area of the velopharyngeal port increased from 0 to 25 mm 2 . A total of 5 airflow patterns with distinct features were captured, corresponding to adequate closure, adequate/borderline closure (Class I and II), borderline/inadequate closure, and inadequate closure. The maximal orifice area that could be tolerated for adequate VP closure was determined to be 2.01 mm 2 ., Conclusion: Different VP functions are of characteristic airflow dynamic features. Computational fluid dynamic simulation is of application potential in individualized VP surgery planning.

Recent studies have shown that the Furlow double-opposing Z-plasty has several advantages that make it an attractive procedure for cleft palate repair and treatment of velopharyngeal insufficiency in selected cases. The anatomic changes associated with this procedure have never been documented prospectively. The purpose of this study was to describe radiographic dimensions of the velopharynx and aerodynamic measures of velopharyngeal function in a group of patients before and after Furlow Z-plasty for the treatment of velopharyngeal insufficiency. Twelve consecutive patients with cleft palate and velopharyngeal insufficiency, ranging in age from 3 to 19 years, were selected as candidates for Furlow Z-plasty based on perceptual, endoscopic, and radiographic findings. Eight patients had repaired cleft palate with a residual muscle diastasis and four patients had unrepaired submucous cleft palate. Subjects received aerodynamic and cephalometric assessments before and after Z-plasty. Cephalometric x-rays were measured for velar length, thickness, and pharyngeal depth. Mean nasal airflow during pressure consonants (Vn) was calculated from pressure/flow studies, and patients were categorized as having complete closure (<10 cc/sec Vn) or incomplete closure (>10 cc/ sec Vn). After Z-plasty, there was a significant increase in velar length (p = 0.002) and velar thickness (p = 0.001). After surgery, patients with complete velopharyngeal closure had significantly greater velar length than the incomplete closure group (p = 0.05) with nearly twice the increase in length. Similarly, following surgery, the complete closure group had significantly greater thickness than the incomplete closure group (p = 0.01), with a greater postoperative increase in velar thickness (p = 0.005). Finally, there was a significant negative correlation between percent increase in length and percent increase in thickness for patients in the complete closure group (r = -0.91, p = 0.03). Findings demonstrate that following Furlow Z-plasty, patients with cleft palate and velopharyngeal insufficiency obtained significant increases in velar length and thickness. Greater velar length and greater velar thickness both were associated with complete velopharyngeal closure. Patients in the complete closure group tended to demonstrate large percent gains in either length or thickness or moderate gains in both. Patients in the incomplete closure group tended to demonstrate relatively small percent gains in both dimensions. Results suggest there may be important anatomic features (such as pharyngeal depth/velar length ratio) that can be evaluated before surgery to predict which patients may be most likely to benefit from Furlow Z-plasty as a form of treatment for velopharyngeal insufficiency.

Objective: The objective of this study was to determine the influence of velopharyngeal (VP) inadequacy on respiratory speech compensations., Design: The pressure-flow technique was used to measure pressure, airflow, and timing variables associated with VP closure during the production of the initial plosive consonant /p/ in a series of the utterance "papa.", Setting: The study was conducted in the speech and breathing laboratory of the UNC Craniofacial Center., Participants: Eighty-two subjects with cleft lip and/or palate were assessed. The subjects were divided into two groups, those with adequate VP closure (VP size <.010 cm2) and those with inadequate VP closure (VP size >0.10 cm2). The adequate group was comprised of 62 subjects, and 20 subjects were categorized as inadequate., Results: Peak intraoral pressure decreased in the inadequate group, but the difference was not significant. Nasal airflow increased (p < .01), but duration of the pressure pulse was the same for both groups. The area under the pressure curve decreased for the inadequate group (p = .04)., Conclusion: These data contrast with previously reported published data using /p/ in the utterance "hamper." This suggests that phonetic context influences the compensatory response to velopharyngeal inadequacy. Additionally, while the findings are somewhat similar to studies that involved noncleft subjects whose oral airway was suddenly vented during the production of /p/, there is enough difference to suggest that learning also affects the compensatory outcome.

Intraoral air pressure (P0), nasal airflow, and nasal air volume characteristics were determined from 63 adults speakers during production of oral and nasal consonants. The speakers were categorized into two age groups. Young speakers (21 males, 21 females) ranged in age from 18 to 37 years (mean = 24); older speakers (10 males, 11 females) ranged in age from 68 to 83 years (mean = 75). Speakers produced the syllables /pi/ and /si/ and the word "hamper" at self-determined loudness levels during reiterant speech tasks. Results indicated similar velopharyngeal function between young and older adults as reflected by nasal airflow and air volume measures. Older adults, however, exhibited significantly higher levels of P0 than younger adults during production of /p/ in "hamper." In addition (a) male speakers exhibited higher P0 than females during production of /p/ in "hamper," (b) all speakers demonstrated declination of P0 during production of /p/ in "hamper" as a function of word position in the utterance, and (c) male and female speakers exhibited different patterns of nasal air volume during production of "hamper" as a function of word position in the utterance. The intraoral air pressure results suggest differences in respiratory function between young and older speakers. The nasal air volume results suggest a gender specific velopharyngeal declination effect. Implications for velar motor control strategies are discussed.

The pathogenesis of obstructive sleep apnea (OSA) remains unknown. However, we are beginning to understand the mechanisms leading to sleep apnea by evaluating the structure and function of the upper airway (UA) and the surrounding soft-tissue structures using sophisticated magnetic-resonance-imaging techniques. Knowledge of the morphology and mechanical behavior of the soft-tissue structures is essential for a complete understanding of the physiology of the UA. Although the tongue and soft palate have been considered the most important UA soft-tissue structures, our data have highlighted the importance of the lateral pharyngeal walls in the mediating UA caliber. We have demonstrated that: (1) during wakefulness, the predominant anatomic abnormality underlying UA narrowing in patients with OSA is thickening of the lateral pharyngeal walls; (2) during respiration, there are significant changes in lateral airway dimensions as well as in the thickness of the lateral walls; and (3) incremental levels of continuous positive airway pressure (CPAP) result in progressive thinning of the lateral pharyngeal walls. The dynamic biomechanical behavior of the lateral pharyngeal walls during wakefulness, sleep, and during apneas needs to be investigated.

Aerodynamic and temporal characteristics of velopharyngeal function were determined for 42 adult male and female speakers. All subjects produced the word "hamper" at self-determined loudness levels and rates of speaking. Measurements of intraoral air pressure, nasal airflow, and estimates of velopharyngeal orifice size were obtained during production of the /m/ and /p/ segments. Volume measurements of nasal airflow were determined for the entire word, the /m/ segment, and the segments preceding /m/. Fifteen timing measures associated with the pressure-flow events of the nasal-plosive sequence were also determined. Results indicated that males generated significantly higher levels of peak intraoral air pressure than females during /p/. Male speakers also exhibited a significantly shorter interval in the rise of oral pressure associated with the /p/ segment. Male and female speakers, however, exhibited similar levels of anticipatory coarticulation as reflected by nasal air volume measurements. Finally, variability of selected measurements within speakers suggested that temporal aspects of velopharyngeal function were more constrained than aerodynamic aspects. The results are discussed relative to (a) sex differences in respiratory and velar function and (b) normative data for adult speakers.

To determine the structural basis for alterations in upper airway (UA) collapsibility, the pharyngeal critical pressure (Pcrit) was measured in an isolated feline upper airway preparation. The effect of airway elongation and dilation was explored by displacing the trachea caudally and the tongue anteriorly, respectively. With caudal-tracheal displacement, Pcrit fell progressively, a result that can be attributed to increased tension within the pharyngeal mucosa. In contrast, anterior-tongue displacement decreased Pcrit when the trachea had been caudally displaced but not with the trachea in the neutral position. These findings suggest that longitudinal tension within the airway mucosa modulates both Pcrit and the response in Pcrit to dilating forces. A mechanical model to account for these findings is discussed.

Snoring is characterized by high-frequency (30-50 Hz) pressure oscillations (HFPO) in the upper airway (UA). The soft palate is a major oscillating structure during snoring, and soft palate muscle (SPM) activity is an important determinant of velopharyngeal patency. Consequently, we examined the effect of artificial HFPO applied to the UA on the integrated electromyographic (EMG) activity of the SPMs in 11 supine mouth-closed anesthetized (pentobarbital sodium/chloralose) dogs breathing spontaneously via a tracheostomy. The EMGs of the palatinus (Pal; n = 11), levator veli palatini (LP; n = 9), and tensor veli palatini (TP; n = 8) were monitored with intramuscular fine-wire electrodes. Peak inspiratory and peak expiratory EMG activity was measured in arbitrary units (au) as the mean of five consecutive breaths. HFPO [+/- 4.5 +/- 0.4 (SE) cmH2O; 30 Hz] applied at the laryngeal end of the isolated UA increased peak inspiratory EMG from 3.3 +/- 2.0 to 8.4 +/- 1.7 au (P < 0.05) for Pal and from 2.0 +/- 1.1 to 7.3 +/- 2.7 au (P < 0.05) for LP. For the TP, increases were evident in four dogs, but mean values for the group did not change (5.8 +/- 2.4 to 11.0 +/- 4.1 au, P = 0.5). The peak expiratory EMG did not change for any SPM (all P > 0.3). Thus HFPO applied to the UA augments inspiratory SPM activity. Reflex augmentation of SPM activity by HFPO may serve to dilate the retropalatal airway and/or stiffen the soft palate during inspiration in an attempt to stabilize UA geometry during snoring.

We examined the integrated (MTA) electromyographic activity (EMG) of the hyoepiglotticus (HE) muscle and the soft palate muscles (SPM) during CO2 administration in 6 anaesthetised prone, mouth open dogs. As ventilation increased nasal flow (VN) as a percentage of total flow (VT), i.e. VN/VT%, decreased. Breath-by-breath peak inspiratory and peak expiratory HE EMG activity was strongly and inversely correlated with VN/VT% (both r > 0.8, p < 0.001), whereas the correlation between SPM MTA EMG activity and VN/VT% was highly variable. Severing of the HE muscles halved the rate at which VN/VT% was reduced with respect to increasing ventilation while electrical stimulation of HE muscle contraction resulted in a fall in VN/VT% to near zero levels. Active control of epiglottic position appears to be an important mechanism controlling the patency of the epiglottic-soft palate seal and thus the oronasal partitioning of airflow in dogs.

The purpose of this investigation was to study the operating range of the levator veli palatini muscle for a nonspeech task (blowing) and to determine where in that range levator activity for speech lies. Ten adult subjects without speech or velopharyngeal abnormalities participated. Levator EMG activity for speech occurred in the lower region of the total range for blowing. In two subsequent experiments involving a subset of 4 subjects, it was found that overall effort may have had a small effect on levator activity apart from its role in velopharyngeal closure for aerodynamic purposes. The results of the main experiment are discussed in relation to the concept of threshold of fatigue as it may influence velopharyngeal control mechanisms.

Continuous positive airway pressure (CPAP) therapy can be used to reduce hypernasality by elevating the air pressure in the nasal cavities during speech. The purpose of this study was to determine whether increased intranasal air pressure loads the major muscle of velopharyngeal closure, the levator veli palatini. Nine subjects, four with cleft palate and five without cleft palate, were studied. Electromyographic activity was measured from the levator veli palatini muscle with several levels of air pressure delivered to the nasal cavities using a commercially available CPAP instrument. It was found that levator veli palatini activity was significantly greater for the positive air pressure conditions than for the atmospheric pressure conditions for both subject groups. This indicates that the levator veli palatini muscle acts against the resistive load produced by the increased intranasal air pressure. The results support the use of CPAP therapy as a method of resistance exercise for strengthening velopharyngeal closure muscles.

Pressure-flow data are often used to provide information about the adequacy of velopharyngeal valving for speech. However, there is limited information available concerning simultaneous pressure-flow measurements for oral and nasal sound segments produced by normal speakers. This study provides normative pressure, flow, and velopharyngeal orifice area measurements for selected oral and nasal sound segments produced by 10 male and 10 female adult speakers. An aerodynamic categorization scheme of velopharyngeal function, including one typical category and three atypical categories (open, closed, and mixed) is proposed.

Pressure-flow data are often used to provide information about the adequacy of velopharyngeal valving for speech. However, there is limited information available concerning simultaneous pressure-flow measurements for oral and nasal sound segments produced by normal speakers. This study provides normative pressure, flow, and velopharyngeal orifice area measurements for selected oral and nasal sound segments produced by 10 male and 10 female adult speakers. An aerodynamic categorization scheme of velopharyngeal function, including one typical category and three atypical categories (open, closed, and mixed) is proposed.

A two-part study was conducted to determine the accuracy of the pressure-flow method in estimating induced velopharyngeal orifice areas when the flow coefficient k was empirically determined. In Study 1, short tubes, 4.5 cm in length and with internal diameters of 3.2, 4.8, and 6.4 mm, were placed in a model of the vocal tract, and the associated flow coefficients were calculated. In Study 2, the 4.8-mm internal diameter tube was inserted into the nasopharynx of a normal adult subject to induce oronasal coupling during production of the syllable/pa/. Results for the human subject revealed that the error between the known and estimated orifice areas was approximately 7%. This finding indicates that the pressure-flow technique is accurate when the flow coefficient of the orifice is known. It is suggested that future research attempt to estimate flow coefficients associated with the geometry of the human velopharyngeal orifice in order to improve the accuracy of the pressure-flow technique.

Cineradiographic study of the movement patterns of oropharyngeal and laryngeal structures during breathing and panting in dogs, correlated with recordings of expiratory and inspiratory airflow patterns (via thermocouples) at the nose and mouth show that the soft palate is the principal structural component regulating the path of respiratory in these animals. Cyclical movements of the soft palate during panting are accompanied by complementary movements of the posterior dorsum of the tongue (and epiglottis) to open and to close alternately the oropharynx and nasopharynx. The epiglottis appears to play a passive role during changes in airflow direction; its movements at this time being closely coupled to movements of the posterior tongue and hyoid. The dogs did not breathe during lapping or mastication, indicating the loss of functional separation of respiratory and feeding activities - a role traditionally held for the evolution of a secondary palate in mammals. Food stored in the posterior region of the oral cavity was observed to obstruct airflow via the nasopharynx during food transport and breakdown. Respiration commenced only after the food bolus had been swallowed. We suggest that specializations of the soft palate and epiglottis in dogs for thermal panting appear to restrict the formation of an adequate oropharyngeal seal during feeding.

The purpose of this study was to demonstrate a new application of the pressure-flow technique and to determine whether the temporal characteristics of aerodynamic data associated with single-word utterances could reliably differentiate speakers with adequate palatopharyngeal closure from those with inadequacy. The groups included 10 normals, 20 patients with cleft palate who had adequate closure (0.0-0.09 cm2), 20 patients who had borderline closure (0.10-0.19 cm2), and 20 patients who had inadequate closure (greater than 0.19 cm2). The test sound was the nasal-plosive blend /mp/ in the word hamper. The data were processed by a PDP 11/34 computer. The results demonstrate the utility of the pressure-flow technique for studying timing parameters associated with speech and reveal that patients with adequacy of closure can be differentiated from those with inadequacy using timing criteria. Additionally, the data suggest that the perception of nasal resonance in the group with borderline closure appears to be influenced by the timing of closure.

In 20 naive patients without respiratory impairment, we investigated the ability of the soft palate to direct airflow during breathing. Patients were connected to a spirometer, without noseclip. No instructions were given on the breathing route. During quiet respiration, 15 patients breathed solely through the nose, despite an open mouth. During forced vital capacity (FVC) maneuvers, 19 patients expired exclusively through the mouth. When specifically asked to breathe quietly through the mouth, pure nasal breathing was no longer observed. Tidal volume (VT) or FVC were comparable when patients were asked to breathe through the mouth, with or without noseclip: 0.67 +/- 0.46 vs. 0.60 +/- 0.21 liter for VT (mean +/- SD); 4.05 +/- 0.65 vs. 4.18 +/- 0.70 liters for FVC. In eight separate healthy volunteers, the soft palate was shown by fluoroscopy to close the oropharyngeal isthmus during quiet breathing (resulting in pure nasal breathing) and to close the nasopharynx during FVC efforts (resulting in mouth breathing). During oronasal breathing, the soft palate lay in between the tongue and the posterior pharyngeal wall. These data suggest that when both mouth and nose are open, the soft palate is responsible for the partitioning of oronasal flow.

Nasal air flow was measured during the speech of 112 normal subjects (59 females and 53 males) ranging in age from three years to 37 years, six months. Flow was zero during nearly all oral consonant and vowel utterances, suggesting that velopharyngeal closure was air-tight. Flow occurred during all nasal consonants and during vowels adjacent to nasal consonants. These effects were interpreted as showing that progressively older subjects and female subjects demonstrate earlier anticipatory coarticulation in preparation for forthcoming nasal consonants.

During pursed-lips (PL) breathing, even though expiratory air-flow resistance is probably higher than during nasal breathing, there is no air flow through the nose. This should imply an active mechanism that prevents air from escaping through the nares. In 6 patients with chronic obstructive lung disease (FEV1/FVC 34.5 +/- 11.8%; mean +/- 1 SD), nasal resistance averaged 2.6 +/- 0.5 cm H2O.L-1.s-1, whereas translabial resistance (during PL expiration) was 5.7 +/- 0.7 cm H2O.L-1.s-1 (p less than 0.005 by paired t test). Nasal air flow during PL expiration was zero. In all patients, cineradiographic studies showed during the expiratory phase of PL breathing that the soft palate rose to closely contact the posterior pharyngeal wall, completely occluding the entrance to the nasopharynx. This upward movement of the soft palate was of active nature. The palate muscles should be considered as accessory respiratory muscles.