Precise assessment of velopharyngeal function is the essential first step in correcting cleft palate speech either by speech therapy or by surgery.
Several diagnostic means are now available to assess velopharyngeal function, among which fluorovideoradiography and nasopharyngofiberscopy seem to be most clinically useful.
This paper describes combined fluorovideoradiography and nasopharyngofiberscopy in patients with cleft palate and the effectiveness of three dimensional fluorovideoradiographic and nasopharygofiberscophic in the observation of lateral, frontal and downward views during speech. It was also found that some velopharyngeal incomptences are accompanied by special faulty articulations which can be corrected by speech therapy.
Subjects
Examinations were conducted on 100 patients with repaired cleft palate and repaired or unrepaired submucous cleft palate and congenital velopharyngeal incompetence, who were suspected of having velopharyngeal incompetence.
Method
Fluorovideoradiography and nasopharyngofiberscopy videotapes were analyzed with an editing controller SONY RM-450. In some patients who showed typical abnormal articulately movement, observations and analysis were repeated frame by frame.
Results
The ratio of the length of the soft palate to the depth of the pharynx (soft palate/pharynx) is important.(If the ratio is below 1.2, surgery is necessary) Knee shape and mobility of the soft palate and posterior pharyngeal wall (including Passavant's ridge), in the lateral view of fluorovideoradiography and movement of the lateral seems pharyngeal wall toward the medial line in flontal view.
In the downward view of nasopharyngofiberscopy, we observed movement of the velum, lateral wall and posterior wall (passavant's ridge).
We found that velopharyngeal incompetence was accompanied by glottal stops, but this false incompetence disappeared when the speech sequences showed absence of glottal stops.
Therefore, it is very important to determine by three dimensional observation whether or not there is interaction between articulatory movements, especially of the tougue and larynx, and velopharyngeal function.
