الفهرس 
Physiology 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.
This study aimed to recommend certain criteria for decision making for proper management of patients with residual velopharyngeal insufficiency following primary repair of cleft palate depending on auditory perceptual assessment, the velopharyngeal gap and pattern of closure assessed through multi-view videofluoroscopy, nasoendoscopy and nasometer.
This study has been carried out on 31 patients (who are attending on the out patient clinic of the phoniatric unit; Mansaura university hospitals) with residual velopharyngeal insufficiency after primary repair of cleft palate. Their ages were above 3 years and with average mentality.
The patients have been classified in to four groups according to the APA, the velopharyngeal port gap area and the pattern of closure.
Group (A): This group included 9 patients complaining of slight to mild degree of open nasality. Their gap areas were 2-3 mm during phonation with good closure reaching 3-4 degree with varies closure patterns. These patients have been treated by speech therapy alone.
Group (B): This group included 10 patients suffering from mild to severe degree of open nasality. Their gap areas during phonation were more than 2 mm with coronal or circular (mainly coronal) pattern of closure. These patients have been treated by sphincter pharyngoplasty followed by speech therapy.
Group (C): This group included 5 patients suffering from moderate to severe degree of open nasality. Their gap areas were more than 2 mm with sagittal or circular (mainly sagittal) pattern of closure. These patients have been treated by sphincter pharyngoplasty followed by speech therapy.
Group (D): This group included 7 patients suffering from moderate to severe degree of open nasality. Their gap areas were more than 2 mm with sagittal or circular (mainly sagittal) pattern of closure. These patients have been treated by superiorly based pharyngeal flap followed by speech therapy.
A pre test was done before management to evaluate all the patients in the four groups using the protocol of assessment applied in phoniatric unit, Ain-Shams University. It includes subjective as well as quasi-objective measures of evaluation. A mid test was done to the patients in groups (B), (C) and (D) three weeks following the surgical management using APA as a subjective method and nasometer as an objective method. A post test was done to all the patients after speech therapy using the whole protocol of assessment.
The treatment of velopharyngeal insufficiency patients in this study was done by close cooperation and teamwork between the surgeon and the phoniatrician. The surgery was done to correct the anatomical defect, while Speech therapy was required to help the patient to eliminate compensatory productions and learn how to use the flap effectively.
The results of this study demonstrated that modified sphincter pharyngoplasty could be applied effectively to all patients with velopharyngeal insufficiency following cleft palate repair regardless of their velopharyngeal pattern of closure.
This study recommends certain criteria for decision making for proper management of patients with residual velopharyngeal insufficiency following primary repair of cleft palate as follow:
* Speech therapy alone is recommended in cases with: (a) the velopharyngeal gap area is less than 2-3 mm. (b) good velar or lateral pharyngeal walls movement reaching grade 3-4 regardless the pattern of closure of the velopharyngeal port. (c) the compensatory articulatory errors are the main APA problem with slight to mild degree of hypernasality.
* Sphincter pharyngoplasty operation followed by speech therapy is recommended with: (a) the velopharyngeal gap area is more than 3 mm. (b) any pattern of preoperative velopharyngeal closure. The preoperative gap area seen by videofluoroscopy is useful in recommending the bulkiness of the sphincter pharyngeal flap performed. (c) the degree of hypernasality is moderate to severe.
* Pharyngeal flap operation followed by speech therapy is recommended with: (a) the velopharyngeal gap area is more than 3 mm. (b) sagittal pattern of closure only regarding the width of the flap is to be measured and recommended by the aid of videofluoroscopy preoperatively. (c) the degree of hypernasality is moderate to severe.