Acute isolated velopharyngeal insufficiency in children: case report and systematic review of the literature

Acute isolated velopharyngeal insufficiency (VPI) is a clinical entity mainly reported in children. We undertook a systematic review in order to better characterize its features. Following a Medline search (1960-2012), the authors reviewed and analyzed the cases of acute VPI in children; 36 cases were found. The most common presenting features were hypernasal speech (97%), nasal reflux (73%), and dysphagia (49%). 73% of the children were males and 27% females, of 8.9±2.5years. In all the cases the VPI was unilateral. One quarter of the children had a recent episode of febrile illness and 11% of the children had an identified infection at the time of presentation (HAV, parvovirus B19, measles, and Coxsackie virus). No associated cause was found in the other cases. All cases resolved completely (67%) or partially (33%) without any treatment (89%) or with prednisolone (11%). Acute VPI represents a separate entity within the spectrum of VPI and it is a benign self-limiting disorder. The cause remains undetermined but an infectious disorder may play a role at least in some cases. Follow-up is mandatory in order to eliminate progressive conditions such as brainstem neoplasms or inflammatory disease

Treatment of velopharyngeal insufficiency by autologous fat injection

Velopharyngeal insufficiency (VPI) is a structural or functional trouble, which causes hypernasal speech. Velopharyngeal flaps, speech therapy and augmentation pharyngoplasty, using different implants, have all been used to address this trouble. We hereby present our results following rhinopharyngeal autologous fat injection in 18 patients with mild velopharyngeal insufficiency (12 soft palate clefts, 4 functional VPI, 2 myopathy). 28 injections were carried out between 2004 and 2007. The degree of hypernasal speech was evaluated pre- and postoperatively by a speech therapist and an ENT specialist and quantified by an acoustic nasometry (Kay Elemetrics™). All patients were exhaustively treated with preoperative speech therapy (average, 8years). The mean value of the nasalance score was 37% preoperatively and 23% postoperatively (p=0.015). The hypernasality was reduced postoperatively in all patients (1-3 degrees of the Borel-Maisonny score). There were no major complications, two minor complications (one hematoma, one cervical pain). The autologous fat injection is a simple, safe, minimally invasive procedure. It proves to be efficient in cases of mild velopharyngeal insufficiency or after a suboptimal velopharyngoplast

Rhinopharyngeal autologous fat injection for treatment of velopharyngeal insufficiency in patients with cleft palate

Patients with cleft palate are prone to velopharyngeal insufficiency. In minor cases or when hypernasal speech does not resolve after velopharyngoplasty, an augmentation pharyngoplasty with autologous fat can be proposed. The aim of the present study is to evaluate the short-term (within 2 months) and long-term efficiency (during the 24 months following the procedure) of our procedure in the setting of velopharyngeal insufficiency related to a cleft palate. Twenty-two patients with cleft palate related velopharyngeal insufficiency were included in this retrospective study. All patients were operated following the same technique, in the same institution. The pre- and postoperative evaluations included a nasometry, a subjective evaluation using the Borel-Maisonny score, and a nasofibroscopy to assess the degree of velopharyngeal closure. Scores of Borel-Maisonny and nasometry were compared before, shortly after the procedure (within 2 months) and long term after the procedure (within 24 months). Forty-one procedures in 22 patients with a cleft palate performed in our institution between October 2004 and January 2012 were included in the study. Nine patients had a previous velopharyngoplasty with persistent rhinolalia despite intensive speech therapy. In 14 patients the procedure was repeated because of recurrent hypernasal speech after the first injection. The average number of procedures per patient was 1.8. Postoperative nasometry and Borel-Maisonny scores were statistically significantly improved and remained stable until the end of the follow-up (median 42 months postoperative) in most patients. Complications were rare and minor. Autologous fat injection is a simple procedure for treatment of minor velopharyngeal insufficiencies in patients with cleft palate, with good long-term results and few complications

Evidement ganglionnaire cervical endoscopique : une étude portant sur le modèle animal et le cadavre

Introduction: La chirurgie cervico-faciale tend à être de moins en moins invasive, afin de diminuer les complications et les morbidités. C'est dans ce but que nous avons étudié la faisabilité d'un évidement cervical endoscopique (EE). Matériel et méthode: 14 EE sont pratiqués sur 11 Minipigs anesthésiés et 10 EE sur 5 cadavres frais, en employant une technique adaptée de la laparoscopie. Les ganglions restant sont prélevés par chirurgie ouverte et les échantillons sont analysés par un pathologue. Résultats: L'EE est possible chez le Minipig et le cadavre, sans complications majeures, avec un taux d'efficacité d'extraction des ganglions de 80 à 90 % par rapport à la chirurgie traditionnelle. Discussion: Cette étude est la première à démontrer la faisabilité de l'EE sur l'animal et sur le cadavre. Elle permet, d'autre part, de perfectionner les techniques endoscopiques cervicales et d'élargir le spectre des interventions effectuées sur le cou

Clinical Aspects of Velopharyngeal Insufficiency

Velopharyngeal insufficiency (VPI) is due to an incomplete closure of the valve separating the oral and the nasal cavities and manifests as a nasalized voice, articulation problems, and sometimes swallowing disorders. The etiologies are anatomic, neurogenic or functional. The evaluation of VPI remains challenging and is the key to the management. This work provides an overview of current knowledge in velopharyngeal anatomy and physiology, VPI evaluation techniques and therapeutic modalities. A comprehensive review of literature is presented, with a focus on the controversial innervation of the velopharyngeal muscles and on the perceptual and instrumental evaluation of resonance disorders in VPI. Lastly, an attempt is made to identify the “grey” areas still existing in the field of VPI evaluation and treatment, and to define research perspectives

Evaluation des troubles de la voix--une approche multiparamétrique

Voice evaluation is based on perceptive analysis of voice quality and on instrumental assessments, which comprise acoustic and aerodynamic sound measures. Even though perceptive evaluation is considered the gold standard for voice evaluation, it is biased by its subjective nature. Despite the fact that instrumental analysis is considered objective, it has limited reliability. This is why the integration of these two methods into a multiparametric analysis allows a more broad range diagnostic approach for dysphonia

Disseminated gonorrhea with laryngeal involvement in a 25-year-old man

Un cas de gonococcose disséminée avec atteinte laryngée chez un patient de 25 ans est décrit. L'atteinte pharyngée représente environ 3% des cas d'infection par Neisseria Gonorrhoeae, mais son atteinte laryngée n'a jamais été documentée à notre connaissance. Lors d'infection inhabituelle des voies aéro-digestives supérieures, une infection sexuellement transmissible doit être recherchée