Palatal Lift Prosthesis for the Treatment of Velopharyngeal Incompetency and Insufficiency

 
Number of patients
Male
230 (53 %)
Female
201 (47 %)
Type of velopharyngeal Incompetence
No cleft
271 (63 %)
Submucous cleft
86 (20 %)
From trauma
68 (16 %)
From disease
6 (1 %)
Each patient was examined and evaluated by a plastic surgeon, prosthodontist, and speech-­language pathologist with a combined experience of 110 years. A questionnaire was designed for data acquisition and long-term follow-up of these patients (Table 40.2).

Table 40.2

Questionnaire designed to record appropriate information on patients for the study
1. Patient number ______________________________________________________________________________
2. Patient name ________________________________________________________________________________
3. Patient address ______________________________________________________________________________
4. Birth date _________________________________________ 5. Sex ________ Race: ______________________________
6. Referral source ______________________________________________________________________________
7. Chief complaint _____________________________________________________________________________
8. Specific diagnosis:
Congenital VPI, no cleft __________
VPI with cleft __________
VPI with submucous cleft __________
VPI from trauma __________
VPI from cancer __________
VPI with other diseases __________
Iatrogenic VPI __________
Other unclassifiable __________
9. Diagnostic data available
Cephs __________
Lateral only __________
Lateral and AP __________
At ages ___________________________
No cephs _________________ Tracings
Cineradiographs
Yes _________ at ages ___________________________
No _________
Recordings
Yes _________ at ages ___________________________
No _________
Dental models
Yes _________ at ages ___________________________
No _________
Growth analysis
Yes _________ No _________
Sonograms
Yes _________ No _________
Audiology examination
Yes _________ at ages ___________________________
No _________
Surgical records
Yes _________ No _________
10. Other conditions (short narrative or diagnostic classification)
Dental health: _______________________________________________________________________________
Orthodontic: ________________________________________________________________________________
Audiology, otology: __________________________________________________________________________
Allergies: __________________________________________________________________________________
Smoking habits:
No _________ Yes _________ Pack/day
Tonsils and adenoids removed:
Yes _________ age _________
No _________
11. When was VPI first noticed:
Age of onset __________
Circumstance __________
Who first noted VPI __________
12. VIP treatment history
Speech therapy ______________________________ No. of sessions ___________________________________
Surgery (flap) _______________________________ Type of flap ______________________________________
Surgeon ____________________________________ Hospital ________________________________________
Other surgery _______________________________ Procedure _______________________________________
Surgeon ____________________________________ Hospital ________________________________________
Prosthesis __________________________________ Type of prosthesis _________________________________
Prosthodontist _______________________________ Hospital/clinic ___________________________________
13. Sequence of treatment (if multiple procedures)
Speech therapy only __________
Flap and speech __________
Flap only __________
Lift and speech __________
Lift only __________
Speech and flap __________
Speech and lift __________
Flap and lift __________
Lift and flap __________
Three procedures sequence:
1. _______________________ 2. _______________________ 3. _______________________
14. Evaluation of result (speech)
Date of last follow-up __________
Acceptable __________
Not acceptable __________
Acceptable but can improve __________
Not acceptable but can improve __________
No improvement likely __________
Should recall patient __________
15. Recommendations
Today’s date ____________________________ Preparer’s signature ____________________________

40.1.1 The Referral

It is interesting to note that 256 patients (59 %) were referred by speech-language pathologists (Table 40.3), indicating that velopharyngeal incompetency is not recognized at an early age and that the diagnosis is frequently made when the patient starts school. The number of physician referrals was 96 (22 %). The remaining referrals (19 %) came from rehabilitation counselors, dentists, rehabilitation centers, and families.

Table 40.3

Referral source for VPI patients
Source
No. of referrals
Percent of sample (%)
Speech pathologist
256
59
Physician/surgeon
98
23
RN (nurse)
23
5
Dentist
12
3
PDH/BVR
23
5
Rehabilitation center
1
0.5
Social worker
2
0.5
Family
18
4
Please note that 104 patients (25 %) had had their tonsils and adenoids removed in order to eliminate or remedy the velopharyngeal incompetency (Table 40.4). This, of course, causes an increase in hypernasality for the VPI patient.

Table 40.4

Status of tonsils and adenoids of VPI pallechts
Status of adenoids
No. of cases
Percent of sample (%)
In
100
23
Out
104
24
In/out (to insert pharyngeal flap)
14
3
No information available
213
50
In addition to oral examination, nasal endoscopy, and individual judgment, all patients had two cephalometric radiographs taken, one with the soft palate at rest and the second during prolonged phonation of the vowel “E.” Twenty-five percent of the subjects had cineradiographic ­studies of the velopharyngeal region to observe continuous phonation.

40.1.2 Results of Treatment

According to nasal endoscopic evaluation, radiographic analysis, and listener judgments, 126 (29 %) of the patients demonstrated inconsistent or borderline velopharyngeal dysfunction (Table 40.5). The team decided that each subject was to be referred to a speech-language pathologist with instructions to have a review by the team in 1 year if the condition persisted. Further evaluation of these patients after 1 year revealed that the hypernasality or nasal emission had subsided, and none required further treatment.

Table 40.5

Treatment methodology for patients with VPI
Treatment
No. of cases
Percentage of sample (%)
Speech only
126
29
Pharyngeal flap
122
28
Pharyngeal flap recommended
55
13
Palatal lift
74
17
Palatal lift removed after stimulation
8
2
Palatal lift recommended
15
3
Pharyngeal flap – palatal lift
16
4
Palata lift – pharyngeal flap
12
4
It was recommended that 177 patients (41 %) have pharyngeal flap surgery. In 122 patients (mean age, 10 years), the surgical procedure consisted of a superiorly based flap performed by our staff plastic surgeon. The remaining 55 subjects were referred to the plastic surgeon of their choice for a pharyngeal flap with instructions to return to the clinic after insertion of the flap for further evaluation.
Only gold members can continue reading. Log In or Register to continue

Oct 18, 2015 | Posted by in General Dentistry | Comments Off on Palatal Lift Prosthesis for the Treatment of Velopharyngeal Incompetency and Insufficiency
Premium Wordpress Themes by UFO Themes