الفهرس 
Anatomy of the Velopharyngeal PortOnly 14 pages are availabe for public view
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Abstract
The main hazard of velopharyngeal insufficiency (VPI) is a disruption of speech mechanism and a deterioration of communicative ability. It affects speech by several means; mainly hypernasality, imprecision of consonants articulation, audible nasal emission of air and faulty compensatory articulatory mechanisms.
It is obvious that diagnostic accuracy is critical to consistently good treatment outcomes. Various mechanical devices have been developed to assess and measure the velopharyngeal port. This study aimed to assess the velopharyngeal port using multi-view videofluoroscopy in order to validate its role as a clinical tool for assessment of patients with velopharyngeal incompetence for proper management of such patients.
Ten subjects with hypernasality of different aetiological categories have been examined. Every patient was subjected to the protocol of assessment that is applied in phoniatric unit, Ain Shams University that includes subjective as well as quasi-objective measures of evaluation. Multi-view videofluoroscopy was performed to the all 10 patients using the protocol of videofluoroscopic assessment that is applied in Phoniatric Unit, Mansoura University.
Measures obtained using multi-view videofluoroscopy of the velopharyngeal port were found to be correlated with all APA items indicating its validity as a clinical tool for diagnosis of VPI. On the other hand, videofluoroscopic measured parameters such as velar asymmetry, posterior tongue movement, presence or absence of Passavant’s ridge, adenoid and alveolar fistula were found to be of non-significant value in assessment.
Regarding the comparative study between videofluoroscopic assessment and nasoendoscopic assessment of the velopharyngeal port, this study demonstrated statistically non-significant differences using either videofluoroscopy or nasoendoscopy. However, the only statistically significant difference that was detected in 40% of cases in this study was in the assessment of lateral pharyngeal wall movement This could be explained by the fact that complete visualization of the velopharyngeal orifice by the use of nasoendoscopy was not possible owing to the dead angle created by the elevated velum in the cases with good velar movement. There are different kinds of information provided by each examination and limited in the other. Therefore, it was recommended that all patients with VPI should be examined by both videofluoroscopy and nasoendoscopy. Utilizing the two procedures together overcomes the weaknesses of each, and at the same time enhances the strengths of both.
This study presented a very simple and reliable method for quantitative measurement of the velopharyngeal gap assessed by multi-view videofluoroscopy. The velopharyngeal gap was traced on the monitor and measured through the lateral, frontal and Towne’s views. The radio-opaque 1cm2 bars, that were traced and measured on the monitor, were used to correct the errors of magnification of X-ray camera.
CT scanning represents a feasible non-invasive objective technique for measurement of the velopharyngeal port area and the amount of displacement of the components of the port all in a single picture. The comparison between videofluoroscopy and CT that was done in this study revealed statistically non-significant differences between CT measurement and videofluoroscopic measurement of velopharyngeal gap area at rest and during phonation of /a/ sound. This finding validates the use of multi-view videofluoroscopy in quantitative measurement of velopharyngeal gap area using the suggested method in the study.
This study also proved that videofluoroscopy may be preferred to CT because of the advantages of the greater sensitivity of the TV recording system, the reduction in total radiation dosage and the ability to assess in real time motion the velopharyngeal port both during sustained phonation and connected speech. Video-recordings are also available for repeated retrieval, in contrast to CT which presents static photos for the different cuts obtained. Also CT has to be checked against cost effectiveness, possible excessive exposure to irradiation and the quantitative data which could be measured by videofluoroscopy