Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

Acoustic rhinometry is routinely used for the evaluation of nasal patency. Objective: To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). Methods: Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (ΔV) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased /k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6 cm3 and 15.9±3.8 cm3 (AVF group), and 22.7±7.9 cm3 and 20.7±7.4 cm3 (IVF group), corresponding to a mean ΔV decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ΔV decay of 2.0 cm3 (9%) for the IVF group (

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

Acoustic rhinometry is routinely used for the evaluation of nasal patency. Objective: To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). Methods: Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (ΔV) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased /k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6 cm3 and 15.9±3.8 cm3 (AVF group), and 22.7±7.9 cm3 and 20.7±7.4 cm3 (IVF group), corresponding to a mean ΔV decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ΔV decay of 2.0 cm3 (9%) for the IVF group (p<0.05). Seventy percent of the IVF individuals showed a ΔV suggesting impaired VP function (below the cutoff score of 3.0 cm3 which maximized both sensitivity and specificity of the test), confirming clinical diagnosis. Conclusion: Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of VP activity which characterizes VPI.FAPESPCNPqCAPE

Speech resonance after septoplasty in a patient with bilateral cleft lip and palate

Purpose: The nasal airway is an important regulator of the pressures generated in speech when velopharyngeal function is altered. Patients with cleft palate often have nasal obstruction and increased nasal resistance, which can compensate a possible velopharyngeal dysfunction (VPD) and mask hypernasality. Clinical report: A 16 yearold patient, male, underwent nasometric and rhinomanometric assessment before and one year after septoplasty and bilateral inferior turbinectomy surgery. Nasometry was used to evaluate the nasalance scores (acoustic correlate of nasality) during the reading of a set of 5 sentences containing predominantly nasal sounds (nasal text) and a set containing exclusively oral sounds (oral text). Rhinomanometry permits the determination of the minimum nasal cross-sectional area (CSA) by the simultaneous measurement of the differential transnasal pressure and nasal air flow during resting breathing. Before surgery, the nasalance values were 40% and 26% in nasal and oral text, respectively, indicating hyponasality. Rhinomanometry showed that the values obtained for nasal area were 0.571cm2 and 0.094cm2 in the right and left sides respectively indicating a reduced nasal CSA of the left side. After surgery, there was an increase in nasalance to 55% in the nasal text and to 40% in the oral text, indicating hypernasality. Rhinomanometry indicated that nasal area were 0.237cm2 and 0.287cm2, in the right and left sides respectively. Conclusion: The surgery resulted in an increase of the nasal area and improving nasal patency. However, hypernasality was demonstrated. These results confirm what has already been reported by Warren et al (1992) in stating that in the presence of VPD "a good nose for breathing is often a bad nose for speech"

Prevalence of heredity in children born with cleft lip and palate

Background and purpose: The incidence of heredity as a factor for the occurrence of cleft lip and palate is remarkable, as shown by the high number affected relatives. Therefore, this study investigates the prevalence of heredity on children aged 0 to 3, born with cleft lip and palate, cared for in HRAC. Methods: This is a descriptive, quantitative and retrospective study involving 325 children born with cleft lip and palate, as well as with associated anomalies. Results: Out of the 325 children, 106 (49.23%) had at least one family member who was also born with cleft lip and palate. The greatest incidence of heredity happened among cousins, this relationship being present in 70 cases (21.54%), followed by maternal/paternal uncles (29 cases - 8.92%), parents (14 cases - 4.31%), brothers (7 cases - 2.15%), grandparents (4 cases - 1.23%) and great-grandparents (4 cases - 1.23%). Regarding the type of cleft lip and palate, the most common were cleft palate (105 cases - 32.3%), left unilateral cleft lip and palate (75 cases - 23.07%), bilateral cleft lip and palate (65 cases - 20%) and left unilateral cleft lip (36 cases - 11.07%). Also, Pierre Robin Sequence had its greatest incidence in association with cleft palate on the first child. Conclusions: A positive relationship was found regarding the occurrence of cleft lip and palate among the relatives of the children included in the sample. We emphasize the importance of providing adequate orientation to families, focusing on a responsible family planning and providing information on the heightened occurrence risks of cleft lip and palate if there is already a family member affected, as well as on prevention measures to avoid associated anomalies

Comparative analysis of velopharyngeal activity assessed by acoustic rhinometry and nasoendoscopy

Objetivo: Analisar a atividade velofaríngea (VF) de indivíduos com disfunção velofaríngea (DVF) aferida por rinometria acústica, comparativamente à atividade observada por nasofaringoscopia. Modelo: Estudo clínico prospectivo. Participantes: 25 indivíduos com fissura de palato±lábio reparada e DVF residual, adultos, de ambos os sexos. Variáveis analisadas: Variação volumétrica da nasofaringe (V) na produção da plosiva velar /k/ relativamente ao repouso, aferida por rinometria, e, padrão e extensão do movimento VF no /k/, avaliados por juízes, em registros nasofaringoscópicos. Resultados: Observou-se uma redução média no volume da nasofaringe (V) de 15%, significantemente menor (p<0.05) que a variação percentual de referência (30%). Em 72% dos pacientes, a redução foi <3cm3, resultado compatível com o diagnóstico da DVF, e em 28%, foi 3cm3, apesar da DVF. O padrão de gap circular (CI) foi observado em 76% dos casos e o coronal (CO) em 24%. A extensão do movimento VF foi julgada adequada(A), moderada(M) e inadequada(I) em 64%, 24% e 18%, respectivamente. O V não diferiu entre CI e CO e entre A, M e I. Tendência a aumento do V com o aumento da extensão do movimento foi observada. A concordância entre os métodos no diagnóstico da DVF ocorreu em 56% dos casos. Conclusão: A rinometria foi capaz de identificar o comprometimento da atividade VF na maioria dos indivíduos estudados. Contudo, a variação volumétrica da nasofaringe não mostrou correlação com o padrão e a extensão do movimento VF, possivelmente por questões metodológicas. Estudos complementares são necessários para definir a acurácia do teste rinométrico na identificação da DVF.Objective: To analyze velopharyngeal (VP) activity of subjects with VP dysfunction (VPD) by acoustic rhinometry, compared to the activity observed by nasoendoscopy. Model: Prospective clinical study. Participants: 25 adults with repaired cleft palate±lip and residual VPD, of both genders. Outcome measures: Nasopharyngeal volume change (V) during the production of the velar plosive /k/ compared to the rest condition, measured by rhinometry, and VP closure pattern and VP structures movement during /k/ production, rated by blinded judges by observing nasoendoscopy recordings. Results: A mean nasopharyngeal volume decrease of 15% was observed, significantly lower (p<0.05) than the reference percentage of change (30%). In 72% of patients reduction was <3cm3, compatible with VPD diagnosis, and in 28%, there was a change 3cm3, despite VPD. A circular gap (CI) was observed in 76% of patients and a coronal gap (CO) in 24%. The VP movement was judged to be adequate (A), moderate (M) and inadequate (I) in 64%, 24% and 18%, respectively. V did not differ between CI and CO and between A, M and I. A tendency for a V increase with increasing VP movement was observed. Absolute agreement between the two methods was observed in 56% of patients. Conclusion: Rhinometry was able to identify the impairment of VP activity in most subjects. However, nasopharyngeal volume changes showed no correlation with the pattern and range of VP movement, possibly due to methodological issues. Additional studies are needed to define the rhinometric test\'s accuracy in identifying VPD

Sleep breathing disorders following secondary Sommerlad palatoplasty for the treatment of velopharyngeal insufficiency

As desordens respiratórias durante o sono (DRS) são mais prevalentes em indivíduos com fissura de palato operada, comparativamente à população em geral, particularmente quando submetidos à cirurgia de retalho faríngeo (RF), rotineiramente usada como intervenção secundária para a correçãoda insuficiência velofaríngea (IVF) residual à palatoplastia primária. A cirurgia promove obstrução mecânica parcial entre a oro- e a nasofaringe, contribuindo para a fala, mas, podendo comprometer a respiração. Evidências apontam como alternativa o rereparo do palato (palate re-repair) de Sommerlad, de natureza menos obstrutiva, e portanto, mais fisiológica. O presente estudo teve por objetivo investigar o efeito da técnica de Sommerlad sobre a qualidade do sono e patência faríngea em crianças e adultos com fissura de palato previamente operada. Para tanto, foram recrutados 82 pacientes com fissura de palato±lábio reparada e IVF. Aplicados os critérios de inclusão, o estudo foi conduzido em 16 crianças (artigo 1) e 13 adultos jovens (artigo 2), de ambos os sexos, avaliados antes e 7 a 14 meses após a cirurgia. A qualidade do sono foi investigada por meio de instrumentos validados (EDSC, Epworth, Berlin e Stanford). Um subgrupo dos adultos foi também avaliado por polissonografia (artigo 2). A patência da região velofaríngea foi avaliada por rinomanometria modificada e patência nasal foi analisada utilizando escala analógica visual, o teste CQ-5 e rinomanometria convencional. A significância das diferenças pré- e pós-operatórias foram investigadas para p< 0.05. Não foram observadas alterações significativas nos parâmetros rinomanométricos e polissonográficos, tampouco nas análises subjetivas, após a cirurgia, indicando patência faríngea e qualidade do sono preservadas. Os resultados confirmam que a cirurgia de Sommerlad é uma opção cirúrgica segura do ponto de vista respiratório. Sua eficácia quanto à fala, já demonstrada em estudo paralelo, somada a risco mínimo de DRS, confirmado no presente estudo, representa um importante avanço no tratamento das fissuras de palato.Sleep-disordered breathing (SDB) is more prevalent in individuals with repaired cleft palate compared to the general population, particularly when undergoing a pharyngeal flap (PF) surgery, usually performed as a secondary intervention for the correction of residual velopharyngeal insufficiency (VPI) following primary palatoplasty. The surgery promotes partial mechanical obstruction between the oro- and the nasopharynx, contributing to speech. However, I may also worsen breathing. Evidences indicate that the Sommerlad palate re-repair, which has a more physiological approach, may be an alternative. The present study aimed to investigate the effect of the Sommerlad technique on sleep quality and pharyngeal patency in children and adults with previously operated cleft palate. Eighty-two patients with repaired cleft palate±lip and VPI were recruited. After applying the inclusion criteria, the study was conducted in 16 children (Study 1) and 13 young adults (Study 2) of both genders, evaluated before and 7 to 14 months after surgery. Sleep quality was investigated using validated instruments (EDSC, Epworth, Berlin, and Stanford). A subgroup of adults was also assessed by polysomnography (Study 2). Velopharyngeal patency was assessed by modified rhinomanometry and nasal patency was analysed using a visual analogic scale, the CQ-5 test and conventional rhinomanometry. The significance of the pre- and postoperative differences was investigated for P<0.05. No significant changes were observed for all rhinomanometric and polysomnographic parameters after surgery, as for subjective parameters, indicating preserved pharyngeal patency and sleep quality. Results confirm that Sommerlads technique is a safe surgical option from the respiratory point of view. Its efficacy in terms of speech, demonstrated in a parallel study combined to a low risk for S DB, confirmed in the present study, represents a relevant advance in cleft palate treatment

Análise perceptiva e nasométrica da hipernasalidade após a veloplastia intravelar para correção da insuficiência velofaríngea: efeitos a longo prazo

Objetivo investigar o efeito, a longo prazo, da veloplastia intravelar realizada para a corre&#231;&#227;o cir&#250;rgica da insufici&#234;ncia velofar&#237;ngea (IVF) residual, sobre a hipernasalidade de indiv&#237;duos com fissura de palato reparada. M&#233;todos foram avaliados 60 pacientes com fissura de palato&#177;l&#225;bio operada e IVF residual, de ambos os sexos, com idade entre 4 e 52 anos, os quais foram submetidos &#224; palatoplastia secund&#225;ria com veloplastia intravelar. A avalia&#231;&#227;o perceptivo-auditiva da fala foi realizada para classifica&#231;&#227;o da hipernasalidade, durante a conversa&#231;&#227;o espont&#226;nea e a repeti&#231;&#227;o de voc&#225;bulos e frases, utilizando-se escala de 6 pontos, onde 1=aus&#234;ncia e 6=hipernasalidade grave. A nasometria foi utilizada para determina&#231;&#227;o do escore de nasal&#226;ncia (correlato ac&#250;stico da nasalidade), durante a leitura de 5 senten&#231;as contendo sons exclusivamente orais, utilizando-se como limite de normalidade o escore de 27%. As avalia&#231;&#245;es foram realizadas 4 dias antes e 16 meses, em m&#233;dia, ap&#243;s a cirurgia e o sucesso cir&#250;rgico foi analisado com base na propor&#231;&#227;o de redu&#231;&#227;o e elimina&#231;&#227;o/normaliza&#231;&#227;o da hipernasalidade e da nasal&#226;ncia. Resultados verificou-se, ap&#243;s a cirurgia, redu&#231;&#227;o da hipernasalidade e da nasal&#226;ncia em 75% e 52% dos pacientes, respectivamente. Propor&#231;&#245;es menores foram identificadas quando utilizado o crit&#233;rio mais rigoroso de an&#225;lise (elimina&#231;&#227;o/normaliza&#231;&#227;o), ou seja, 32% de elimina&#231;&#227;o da hipernasalidade e 38% de normaliza&#231;&#227;o da nasal&#226;ncia, respectivamente. Conclus&#227;o aveloplastia intravelarmostrou ser um procedimento efetivo, a longo prazo, na redu&#231;&#227;o do sintoma mais significante da IVF residual e deve ser considerada como uma primeira op&#231;&#227;o no tratamento cir&#250;rgico da IVF residual