CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF

CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND ADULTS MSHA 2013 PABLO ANTONIO YSUNZA antonio. ysunza@beaumont. edu

TERMINOLOGY • MALFORMATION: A LOCALIZED ERROR IN MORPHOGENESIS (CLEFT PALATE)

TERMINOLOGY • SEQUENCE: A MALFORMATION CAUSING ANOTHER MALFORMATION (S) • PIERRE-ROBIN SEQUENCE: MICROGNATHIA— GLOSSOPTOSIS—SUB-TOTAL PALATAL CLEFT) • Di. GEORGE SEQUENCE: NEURAL CREST DEFECT —THYMUS ABSENCE, HYPOCALCEMIA, IMMUNE DEFICIENCY

TERMINOLOGY • SYNDROME: GROUP OF MALFORMATIONS WITH COMMON ETIOLOGY (VELOCARDIOFACIAL SYNDROME-22 Q 11. 1 DELETION)

CLEFT PALATE • PRIMARY PALATE • SECONDARY PALATE

CLEFT PALATE

CLEFT PALATE

SUBMUCOUS CLEFT PALATE

SUBMUCOUS CLEFT PALATE

VPI • W / COMPENSATORY ARTICULATION ERRORS (HYPERNASALITY AND ABERRANT PLACEMENT AND MANNER) • WO / COMPENSATORY ARTICULATION ERRORS (HYPERNASALITY WITH APPROPRIATE PLACEMENT AND MANNER)

V P I + COMPENSATORY ERRORS • PROBLEM BEYOND V P S, INVOLVES ENTIRE VOCAL TRACT AND HIGHER LEVELS OF SPEECH PRODUCTION • SPEECH THERAPY IS INDICATED • 1/3 OF RESIDUAL V P I SHOW COMPENSATORY ERRORS • SURGERY DO NOT MODIFY COMPENSATORY ERRORS

VELOPHARYNGEAL SPHINCTER • ANTERIOR: VELUM (LEVATOR VELI PALATINI AND MUSCULUS UVULAE) • LATERAL: LATERAL PHARYNGEAL WALLS (SUPERIOR PHARYNGEAL CONSTRICTOR) • POSTERIOR: POSTERIOR PHARYNGEAL WALL (SUPERIOR PHARYNGEAL CONSTRICTOR)

VIDEOFLUOROSCOPY • X-RAYS • DYNAMIC ASSESSMENT (VIDEO) • ANALYSIS ON VIDEO (DECREASE TOTAL RADIATION TIME) • FRONTAL OR CORONAL, LATERAL OR SAGGITAL, BASE OR AXIAL

RESIDUAL V P I • SYNDROMIC • NON SYNDROMIC

NON-SYNDROMIC V P I • INTRAVELAR VELOPLASTY (L V P SURGICAL REPAIR) • FURLOW Z PLASTY • PHARYNGEAL FLAP • SPHINCTER PHARYNGOPLASTY