Successful and rapid response of speech bulb reduction program combined with speech therapy in velopharyngeal dysfunction: a case report

Shin, Yu-Jeong,Ko, Seung-O Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Velopharyngeal dysfunction in cleft palate patients following the primary palate repair may result in nasal air emission, hypernasality, articulation disorder and poor intelligibility of speech. Among conservative treatment methods, speech aid prosthesis combined with speech therapy is widely used method. However because of its long time of treatment more than a year and low predictability, some clinicians prefer a surgical intervention. Thus, the purpose of this report was to increase an attention on the effectiveness of speech aid prosthesis by introducing a case that was successfully treated. In this clinical report, speech bulb reduction program with intensive speech therapy was applied for a patient with velopharyngeal dysfunction and it was rapidly treated by 5months which was unusually short period for speech aid therapy. Furthermore, advantages of pre-operative speech aid therapy were discussed.

구개열에서 비인두강의 생리해부학적 구조와 과비음과의 연관성 연구

조준희,표화영,최홍식,최병재,손흥규,심현섭 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.4

비인강폐쇄란 연구개, 인두측벽 그리고 인두후벽간의 움직임이 서로 조화되어 구강과 비강을 나누어주는 괄약근 기전으로서 연하, 호흡, 발음 등의 생리적기능에 중요한 역할을 한다. 이 기능에 문제가 생긴 경우를 비인강폐쇄부전이라하며 그 원인으로는 (1) 연구개의 길이 및 움직임이상 (2) 비인두강의 해부학적 공간문제 (3) 인두 후벽과 측벽의 기능이상 등이 있다. 본 연구는 구개열 환자의 측면두부방사선계측사진을 통해 비인두강을 생리해부학적으로 분석하였으며 산출된 말소리의 과비음정도를 Nasometer로 평가하였다. 이로부터 얻은 정상군과 구개열환자군의 결과를 각각 비교하였으며, 비인강폐쇄부전과의 연관성을 알아보기 위하여 Anatomic VPI와 Nasalance score의 값을 비교분석하였다. 얻어진 결과는 다음과 같았다. 1. 측면두부방사선계측사진 결과, 연구개 길이, 연구개 두께, 비인강 깊이, 비인강 면적, Adequate ratio에서 두 그룹간 유의한 차이를 나타내었다. 2. Nasometer 결과. 모음/오/와 구강공명음문장, 구강장해음문장에서 두 그룹 간 유의한 차이를 나타내었다. 3. 구개열환자군에서 비인두강의 폐쇄부전 정도를 표현해주는 Anatomic VPI와 Nasalance score는 전반적으로 연관성이 없었다. 다만, 모음/이/와 일부 구강자음으로 이루어진 문장에서 다소의 상관성을 나타내었다. 결론적으로, 측면두부방사선계측사진과 Nasometer 각각의 검사결과에서 두 그룹간 유의한 차이를 찾아볼 수 있었으나, 구개열환자군내에서 비인강폐쇄부전을 표현하는 Anatomic VPI와 Nasalance score는 모음/이/와 구강자음을 포함한 문장을 제외하고는 전반적으로 연관성이 없었다. Velopharyngeal closure is a sphincter mechanism between the activities of the soft palate, lateral pharyngeal wall and the posterior pharyngeal wall, which divides the oral and nasal cavity. It participates in physiological activities such as swallowing, breathing and speech. It is called a velopharyngeal dysfunction when this mechanism malfunctions. The causes of this dysfunction are defects in (1) length, function, posture of the soft palate, (2) depth and width of the nasopharynx and (3) activity of the posterior and lateral pharyngeal wall. The purposes of this study are to analyze the nasopharynx of cleft palate patients using cephalometry and to evaluate the degree of hypernasality using nasometry to find its relationship with velopharyngeal dysfunction. The following results were obtained : 1. In cephalometry, there were significant differences in soft palate length, soft palate thickness, nasopharyngeal depth, nasopharyngeal area, and adequate ratio between two groups. 2. In nasometry, there were significant differences between two groups in vowel /o/ and sentences including oral consonants. 3. In cleft palate patients, though no general correlation was found between Anatomic VPI and nasalance scores, vowel /i/ and sentences including oral consonants were slightly correlated. In conclusion, cephalometry and nasometer results were significantly different between the two groups. Though in the cleft palate group. Anatomic VPI and nasalance scores, which are indices for velopharyngeal closure, excluding the vowel /i/ and sentences including oral consonants show generally no significance.

구개인두기능부전의 교정을 위한 인두피판술의 나이에 따른 발음 개선 효과

김경훈,배용찬,남수봉,최수종,강철욱 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.3

Purpose: The pharyngeal flap is one of the popular surgical method to treat the problem of velopharyngeal dysfunction. This study evaluated speech outcomes of patients who underwent superiorly based pharyngeal flap surgery based on timing of surgery. Methods: A restrospective review of 50 patients who underwent pharyngeal flap surgery for velopharyngeal insufficiency between September 1996 and January 2008 was undertaken. Thirty patients with an available preoprative and postoperative speech assessments with at least 6 months of follow-up were included in this study. We checked out the significance of speech improvement after surgery analysing preoperative and postoperative scoring of speech assessment. We also investigated the direct relationship between the age at surgery and the degree of speech improvement, and the improvement score in different age groups. Results: The mean score of preoperative speech was 52.6 ± 7.4 points and postoperative speech was 58.6 ± 6.5 points, which presented significant postoperative speech improvement with an average of 5.9 points(p<0.01). There was a significant inverse relationship between the age at operation and speech improvement degree(p<0.01, r = -0.54). Comparing the age groups, the age group of 4 to 5 years presented statistically significant speech improvement(p<0.01). Conclusion: we propose that all patients indicated should take pharyngeal flap irrespective of age. In this study, the younger the age at surgery, the higher degree of speech improvement, for which we suggest that surgical approach should be undertaken as early as possible, especially younger than age 5 years.

구순구개열의 삼킴 및 언어문제

강시현 대한연하장애학회 2013 대한연하장애학회지 Vol.3 No.2

Proper management of swallowing problem in patients with cleft lip and cleft palate before and after proper operation is important for appropriate nutrition. Speech problem is common in patients with cleft palate because of the velopharyngeal insufficiency. I will review in this paper the characteristics of speech problem caused by the velopharyngeal insufficiency and offer several options for evaluation and management of swallowing and speech problems in cleft lip and palate. (JKDS 2013;3:58-61)

한국형 구개열 언어중재법 개발을 위한 기초 연구 : 한국어 조음 지도의 시각적 변인 조사

이은정(Eun-Jeong Lee) 대한구순구개열학회 2020 대한구순구개열학회지 Vol.23 No.2

This study aims to find visual parameters of Korean articulation map to develop speech therapy guidelines for children with CLP. Understanding the anatomical mechanism of Korean alphabet, Hangeul, production is probably the basic step to provide appropriate speech intervention for anybody in need. The Korean consonant consists of relatively high percentage of plosives which need high oral pressure and the manner of voiceless plosive sounds are differentiated by three according to their features called, ‘tense,’ ‘aspirated.’ These features make it difficult to perceive or produce for people who have problems with hearing and/or orofacial structure like cleft palate. As a basic step to develop an articulation place map for Hangeul, this study searched journals on speech perception to find the visual parameters which contribute the most to perceive speech sounds. The extracted visual parameters are as follows: A change of musculature tension and length, movements of orofacial structure, a shape of vocal tract, aerodynamic interactions, and acoustical features released.

CPAP(Continuous Positive Airway Pressure) 치료 프로그램이 취학 전 구순․구개열 아동의 과대비성 개선에 미치는 효과

조성미(Sung-Mi Jo),정옥란(Ok-ran Jeong),한기환(Ki-Hwan Han) 한국음성학회 2007 음성과학 Vol.14 No.4

The purpose of this study was to determine the effectiveness of CPAP (Continuous Positive Airway Pressure) therapy on the treatment of hypernasality in patients with cleft lips and palates. 7 preschool children with severe hypernasality participated in the study. Acoustic measurements of nasality were done by using the NasalView (version 1.31). Results showed that the nasalance values were reduced linearly in both vowels according to the treatment period. The sharp treatment effect was observed at the beginning stage. The nasality values of the vowel /i/ showed a sharp decrease at the Evaluation Phase 1 and 2 and a small increase at the Phase 4 followed by a drop in the end. Further studies would be desirable for various patients with different disorder types.

‘공명장애’ 관련 용어에 대한 소고

이은정 대한구순구개열학회 2018 대한구순구개열학회지 Vol.21 No.2

There are several terminologies which are used in relation to resonance disorders, such as hypernasality, hyponasality, mixed nasality, nasalance score. The Korean terms for these english terminologies are usually rendered into Sino-Korean words and each of them has more than one. This brief review searched articles and books on resonance disorders and listed the Korean renderings of the terminologies to find an opportunity to understand and consider the proper Korean terminologies on resonance disorders.