Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_33_библиотеки_им_акад_М_И_Перельмана
.pdf
with and without cleft palate and the relationship to nasal
airflow paerns. Cleft Palate Craniofac J. 2002;39:409–424.
Fletcher SG. Diagnosing speech disorders from cleft palate. Grune and
Straon: New York; 1978.
Hardin MA, Van Demark DR, Morris HL, Payne MM.
Correspondence between nasalance scores and listener
judgements of hypernasality. Cleft Palate J. 1992;29:346–351.
Hinton VA, Warren DW. Relationships between integrated oral-
nasal differential pressure and velopharyngeal closure. Cleft
Palate Craniofac J. 1995;32:306–310.
Morris HL. Types of velopharyngeal incompetence. Wini H.
Treating articulation disorders: for clinicians by clinicians.
University Park Press: Baltimore; 1984.
Nellis JL, Neiman GS, Lehman JA. Comparison of nasometer and
listener judgements of nasality in the assessment of
velopharyngeal function after pharyngeal flap surgery. Cleft
Palate J. 1992;29:157–163.
Seaver EJ, Dalston RM, Leeper HA, et al. A study of nasometric
values for normal nasal resonance. J Speech Hear Res.
1991;34:715–721.
Smith BE, Guyee TW, Patil Y, Brannan TS. Pressure-flow
measurements for selected nasal sound segments produced by
normal children and adolescents. Cleft Palate-Craniofac J.
2003;40:158–164.
Van Demark DR, Morris HL. Stability of velopharyngeal
competency. Cleft Palate J. 1983;20:18–22.
Warren DW, Dubois AB. A pressure-flow technique for measuring
velopharyngeal orifice area during connected speech. Cleft
Palate J. 1964;1:52–71.
Warren DW, Dalston RM, Morr KE, et al. The speech regulating
system: temporal and aerodynamic responses to
velopharyngeal inadequacy. J Speech Hear Res. 1989;32:566–575.
Waerson T. Nasalance and nasality in low pressure and high
pressure speech. Cleft Palate Craniofac J. 1998;35:293–298.
Waerson T, Hinton J, McFarlane S. Novel stimuli for obtaining
nasalance measures from young children. Cleft Palate Craniofac J.
1996;33:67–73.
392
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
Supplemental Readings
Birch M, Sommerlad BC, Bha A. Image analysis of lateral
velopharyngeal closure in repaired cleft palates and normal
palates. Br J Plast Surg. 1995;47:400–405.
Chen PK, Wu J, Hung KF, et al. Surgical correction of submucous
cleft palate with Furlow palatoplasty. Plast Reconstr Surg.
1996;97:1136–1146 [discussion 1147-1149].
D'Antonio LL, Marsh JL, Provance MB, et al. Reliability of flexible
fiberoptic nasopharyngoscopy for evaluation of velopharyngeal
function in a clinical population. Cleft Palate J. 1989;26:217–225.
Engelke W, Hoch G, Bruns T, Striebeck M. Simultaneous
evaluation of articulatory velopharyngeal function under
different dynamic conditions with EMA and videoendoscopy.
Folia Phoniatr Logop. 1996;48:65–77.
Gildersleeve-Neumann CE, Dalston RM. Nasalance scores in
noncleft individuals: why not zero? Cleft Palate Craniofac J.
2001;38:106–111.
Henningsson G, Isberg A. Comparison between multiview
videofluoroscopy and nasendoscopy of velopharyngeal
movements. Cleft Palate J. 1991;28:413–416.
Karnell MP, Ibuki K, Morris HL, Van Demark DR. Reliability of
the nasopharyngeal fiberscope: analysis and judgement. Cleft
Palate J. 1983;20:199–208.
Karnell MP, Schul K, Canady JW. Investigations of a pressure-
sensitive theory of marginal velopharyngeal inadequacy. Cleft
Palate Craniofac J. 2001;38:346–357.
Kawano M, Isshiki N, Honjo I, et al. Recent progress in treating
patients with cleft palate. Folia Phoniatr Logop. 1997;49:117–138.
Kummer AW, Curtis C, Wiggs M, et al. Comparison of
velopharyngeal gap size in patients with hypernasality,
hypernasality and nasal emission, or nasal turbulence (rustle) as
the primary speech characteristic. Cleft Palate Craniofac J.
1992;29:152–156.
Lewis KE, Waerson T, Quint Q. The effect of vowels on nasalance
scores. Cleft Palate Craniofac J. 2000;37:584–589.
393
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
Mehendale FV, Birch MJ, Birke L, et al. Surgical management of
velopharyngeal incompetence in velocardiofacial syndrome.
Cleft Palate Craniofac J. 2004;41:124–135.
Peterson-Falzone SJ, Karnell MP, Hardin-Jones MA. Cleft palate
speech. 4th ed. Mosby: St. Louis; 2010.
Ramamurthy L, Wya RA, Whitby D, et al. The evaluation of
velopharyngeal function using flexible nasendoscopy. J Laryngol
Otol. 1997;111:739–745.
Searl JP, Carpenter MA. Speech sample effects on pressure and
flow measures in children with normal or abnormal
velopharyngeal function. Cleft Palate Craniofac J. 1999;36:508–
514.
Van Lierde KM, Claeys S, De Bodt M, et al. Outcome of laryngeal
and velopharyngeal biofeedback treatment in children and
young adults: a pilot study. J Voice. 2004;18:97–106.
Vidoo de Sousa T, Lazarini Marques I, Carneiro AF, et al.
Nasopharyngoscopy in Robin sequence: clinical and predictive
value. Cleft Palate Craniofac J. 2003;40:612–617.
Wi PD, Myckatyn T, Marsh JL, et al. Does pre-existing posterior
pharyngeal wall motion drive the dynamism of sphincter
pharyngoplasty? Plast Reconstr Surg. 1998;101:1457–1460.
394
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
1 0
395
https://t.me/medicina_free
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
Physical Management of
Velopharyngeal Inadequacy
When the initial or primary palatoplasty does not provide adequate
velopharyngeal (VP) closure, when closure appears adequate for
speech in early childhood but then changes to inadequate closure as
a result of natural growth or adenoid involution, or when VP closure
is inadequate because of a neuromotor disorder, the team needs to
consider how best to reestablish good VP function. The available
choices are either surgical or prosthetic. The surgical approaches
involve either (1) repositioning the muscles of the velum to increase
velar length and improve the effectiveness of the velar motion or (2)
repositioning the muscles and tissues of the pharyngeal walls or
faucial pillars to change the size and shape of the VP port. The choice
of surgical procedure is usually based on the surgeon's preference.
One hopes that the surgeon's preference is based, in part, on the
appearance and movements of the structures that define the VP port
as seen on nasopharyngoscopic or radiographic speech studies. The
nonsurgical prosthetic approaches to this problem consist of acrylic
plates to cover palatal defects, palatal lifts, and obturators or speech
bulbs to close the VP port during speech.
Individuals whose speech is affected by submucous clefts are also
likely to require physical management. Because the physical signs
are subtle and do not always result in a clinically significant speech
disorder, it is critical that patients who do show the physical signs be
assessed by a speech-language pathologist (SLP) to determine
whether they are actually exhibiting VP inadequacy (VPI). In other
words, submucous clefts do not have to be operated on simply
because they are there. Surgical intervention for these patients may
be considered a primary procedure because typically no previous
palatal surgery was performed. Surgery is usually performed to
reconstruct the levator muscle. Both Cho et al. (2004) and Sullivan et
396
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
al. (2011) reported that the Furlow double opposing Z-plasty was
effective for reconstructing submucous cleft palates.
397
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
Surgical Management of
Velopharyngeal Inadequacy
Levator Muscle Reconstruction Procedures
Many of the surgical procedures used in initial (primary)
palatoplasties to produce a soft palate with the closest
approximation to normal muscle orientation and adequate length
are also used for those same purposes in older individuals with cleft
palate for whom the first surgery did not produce the optimum
result. These procedures have included intravelar veloplasty, Furlow
double opposing Z-plasty, and various modifications of the V-Y
pushback.
Levator reconstruction procedures have essentially replaced
pushback surgical procedures intended to improve velopharyngeal
closure for speech.
Intravelar veloplasty was originally advocated for primary closure
of the soft palate by Kriens (1969, 1970). It is based on findings that
fibers from the left and right levator muscle bundles do not join
normally within the soft palate in children with unrepaired cleft
palate. Intravelar veloplasty involves dissecting the levator bundles
from their abnormal insertions along the margins of the palatal cleft
and repositioning them to approximate a normal levator sling.
Surgeons subsequently experimented with its use not only during
primary palatoplasty but also as a secondary approach to improving
residual VPI.
The Furlow double opposing Z-plasty procedure has received
aention as a levator reconstruction method to improve speech in
select individuals after primary cleft palate repair (Randall et al.,
1986) and in secondary management of VPI (D'Antonio, 1997; Chim
et al., 2015; Dailey et al., 2006). Like intravelar veloplasty, this
procedure reorients the levator muscles to create a functioning
398
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
palatal muscle sling (Fig. 10-1). It also adds some palatal length and
thickness.
FIGURE 10-1 Furlow double opposing Z-plasty. (From Furlow
LT: Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg 78:724-
736, 1986.)
It has yet to be clearly demonstrated how best to identify patients
who could benefit from muscle repositioning. Findings from several
studies have suggested that patients with a smaller VP gap size or
with milder degrees of VPI may benefit from velar muscle
reconstruction and repositioning (Chen et al., 1994; Dailey et al.,
2006; D'Antonio et al., 2000; Hudson et al., 1995; Sie et al., 2001). The
presence of a notch or trough on the nasal surface of the repaired
soft palate is interpreted by some surgeons as evidence of a muscle
diastasis or separation of the left and right levator muscle bundles. If
the two bundles are separated, it is assumed that velar movement
will be less than adequate for speech in a manner typically found in
children with submucous cleft palate.
The advantage of all the levator reconstruction procedures is that
when they work, they do so by approximating or reproducing the
VP physiology that would have been in place if the cleft had not
occurred. In contrast, most forms of pharyngoplasty, particularly
centrally placed pharyngeal flaps, aempt to achieve closure by
mechanisms that are not as physiologically natural.
399
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
Pharyngeal Flap
A pharyngeal flap is typically accomplished surgically by making a
U-shaped incision at the midline of the posterior pharyngeal wall.
The tissue within the U-shaped outline is carefully raised, brought
forward, and inserted into an incision created on the nasal surface of
the soft palate (Fig. 10-2). The ideal result is a midline tissue bridge
extending from the flap's remaining aachment at the posterior
pharyngeal wall to its point of insertion in the soft palate. Two open
spaces on either side of the flap permit nasal respiration, drainage,
and resonance for nasal consonant production (Fig. 10-3). The ability
to create a flap that adequately strikes the delicate balance among all
these demands defines the challenge for the surgeon and the art of
the procedure (Video 10-1 ).
FIGURE 10-2 A pharyngeal flap is typically accomplished
surgically by making a U-shaped incision at the midline of the
posterior pharyngeal wall, carefully raising the resulting
unipedicled superiorly based flap, and suturing it into an
incision created on the nasal surface of the soft palate. (From
Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP: Cleft palate speech [4th ed].
St. Louis: Mosby, 2010.)
400
t.me/Dr_Mouayyad_AlbtousH
https://t.me/medicina_free
Соседние файлы в папке Библиотека им академика М.И. Перельмана