The Submentovertical Projection in the Radiographic Analysis of Velopharyngeal Dynamics

1973 ◽  
Vol 38 (4) ◽  
pp. 473-477 ◽  
Author(s):  
Daniel H. Zwifman ◽  
Michael T. Gyepes ◽  
Frederick Sample
Keyword(s):  
Normal Subjects ◽  
Radiographic Analysis ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Lateral Projection ◽  
Wall Movement ◽  
Normal Individuals ◽  
Pharyngeal Flap ◽  
Surrounding Areas

In assessing lateral pharyngeal wall movement during routine cinefluorographic examination for velopharyngeal adequacy, the inclusion of submentovertical projection is important to the lateral projection of the velum. The main structures of the nasopharynx and surrounding areas are defined, and a method to obtain visualization of this area in normal subjects is described. The degree of lateral pharyngeal wall movement varies among normal individuals and may affect the success of pharyngeal flap operations in patients with velopharyngeal inadequacy.

The Role of Lateral Pharyngeal Wall Movement in Pharyngeal Flap Surgery

1980 ◽  
Vol 66 (2) ◽  
pp. 214-219 ◽  
Author(s):  
Ravelo V. Argamaso ◽  
Robert J. Shprintzen ◽  
Berish Strauch ◽  
Michael L. Lewin ◽  
Avron I. Daniller ◽  
...  
Keyword(s):  
Lateral Pharyngeal Wall ◽  
Flap Surgery ◽  
Pharyngeal Wall ◽  
Wall Movement ◽  
Pharyngeal Flap

Treatment of Asymmetric Velopharyngeal Insufficiency with Skewed Pharyngeal Flap

1994 ◽  
Vol 31 (4) ◽  
pp. 287-294 ◽  
Author(s):  
Ravelo V. Argamaso ◽  
Gerald J. Levandowski ◽  
Karen J. Golding-Kushner ◽  
Robert J. Shprintzen
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Tumor Resection ◽  
Velocardiofacial Syndrome ◽  
Velopharyngeal Insufficiency ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Wall Movement ◽  
Hypernasal Speech

Twenty-two patients, with hypernasal speech and asymmetric velopharyngeal insufficiency (VPI) identified preoperatively by multi-view videofluoroscopy and nasopharyngoscopy, were managed with superiorly based pharyngeal flaps skewed to the side with reduced lateral pharyngeal wall movement. Patient age ranged from 5 to 58 years. The etiology of the VPI included cleft palate with or without cleft lip, neurogenic VPI, velocardiofacial syndrome, tumor resection or latrogenic causes, submucous cleft palate, neurofibromatosis, and hemifacial microsomia. Follow-up, at 1 year and thereafter, showed resolution of VPI in all but two patients. An auxiliary flap to augment the primary flap was added on the side of diminished lateral pharyngeal wall motion which corrected the residual VPI. Three patients developed hyponasality. One was a child whose symptoms improved with time and growth. Two were adults, but the hyponasal resonance was mild and required no further Intervention. The advantage of skewing flaps is that at least one port functions adequately for ease in respiration and for drainage of secretions, thus reducing the risk of nasal obstruction. One open port also allows access for nasoendotracheal intubation should anesthetic be required for future operations.

Effect of a Tongue-Holding Maneuver on Posterior Pharyngeal Wall Movement During Deglutition

1996 ◽  
Vol 5 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Masako Fujiu ◽  
Jeri A. Logemann
Keyword(s):  
Cervical Vertebra ◽  
Posterior Pharyngeal Wall ◽  
Normal Subjects ◽  
Easy Method ◽  
Pharyngeal Wall ◽  
The Past ◽  
Treatment Techniques ◽  
Wall Movement ◽  
Pharyngeal Swallow ◽  
New Treatment

Effects of a tongue-holding maneuver on anterior bulging of the posterior pharyngeal wall (PPW) during swallowing were investigated in 10 young adult normal subjects. Videofluorographic images of 3-ml liquid barium swallows were digitized to quantify the extent of anterior bulge of the PPW with and without the maneuver at the mid and the inferior levels of the second cervical vertebra. A significant increase in PPW bulging was seen with the maneuver at both pharyngeal levels. These findings indicate potential for developing new treatment techniques to facilitate compensatory anterior movement of the PPW, which has not been a target for direct treatment in the past. At present, the tongue-holding maneuver can be employed clinically as an easy method for testing the compliance of the PPW videofluorographically. However, the use of the maneuver per se, which inhibits posterior retraction of the base of tongue (BOT), resulted in increasing the pharyngeal (specifically vallecular) residue after the swallow. The results also indicate the importance of tongue movement in triggering the pharyngeal swallow.

Lateral Pharyngeal Wall Movement During Speech Production

1970 ◽  
Vol 13 (3) ◽  
pp. 584-594 ◽  
Author(s):  
Fred D. Minifie ◽  
Thomas J. Hixon ◽  
Charles A. Kelsey ◽  
Robert J. Woodhouse
Keyword(s):  
Speech Production ◽  
Stop Consonants ◽  
Lateral Pharyngeal Wall ◽  
Pulsed Ultrasound ◽  
Pharyngeal Wall ◽  
Wall Movement ◽  
Time Motion ◽  
High Vowels ◽  
Motion Method

Movement of one lateral pharyngeal wall during the production of VCVCV trisyllables was monitored via pulsed ultrasound using a time-motion method of display. Three normal speakers produced the six English stop consonants* combined with five vowels. The extent of lateral pharyngeal wall movement was found to be greatest on low vowels and least on high vowels. Pharyngeal wall movement during consonant production appeared to be dependent on the adjacent vowels.

Multicenter Interrater Reliability in the Endoscopic Assessment of Velopharyngeal Function Using a Video Instruction Tool

2019 ◽  
Vol 160 (4) ◽  
pp. 720-728 ◽  
Author(s):  
Craig Miller ◽  
Randall Bly ◽  
Shelagh Cofer ◽  
John P. Dahl ◽  
Lianne de Serres ◽  
...  
Keyword(s):  
Posterior Pharyngeal Wall ◽  
Interrater Agreement ◽  
Categorical Variables ◽  
Gap Size ◽  
Lateral Pharyngeal Wall ◽  
Video Instruction ◽  
Pharyngeal Wall ◽  
Wall Movement ◽  
Before And After ◽  
Endoscopic Assessment

Objective Assess interrater agreement of endoscopic assessment of velopharyngeal (VP) function before and after viewing the video instruction tool (VIT). We hypothesized improvement in interrater agreement using the Golding-Kushner scale (GKS) after viewing the VIT. Study Design Prospective study. Setting Multi-institutional. Methods Sixteen fellowship-trained pediatric otolaryngologists who treat velopharyngeal insufficiency (VPI) rated 50 video segments using the GKS before and after watching the VIT. Raters assessed gap size percentage and lateral pharyngeal wall (LPW), soft palate (SP), and posterior pharyngeal wall (PPW) movement. Intraclass correlation coefficient was estimated for these continuous measures. Raters also indicated the presence of a palatal notch, Passavant’s ridge, and aberrant pulsations (categorical variables). Fleiss κ coefficient was used for categorical variables. Wilcoxon signed-rank test was performed on the difference between the pre/post individual video ratings. Results Reliability improved for all continuous variables after watching the instructional video. The improvement was significant for PPW (0.22-0.30, P < .001), SP (left: 0.63-0.68, P < .001 and right: 0.64-0.68, P = .001), and LPW (left: 0.49-0.54, P = .01 and right: 0.49-0.54, P = .09) but not significant for gap size (0.65-0.69, P = .36). Among categorical variables, agreement on Passavant’s ridge significantly improved (0.30-0.36, P = .03). Conclusion Exposure to a video instruction tool improves interrater agreement of endoscopic assessment of VP function. Significant improvement was observed in our primary end points, specifically posterior pharyngeal wall movement, soft palate movement, and lateral pharyngeal wall movement. There was less impact of the VIT on the interrater agreement of the categorical variables, palatal notch, Passavant’s ridge, and aberrant pulsations.

Lateral Pharyngeal‐Wall Movement during Esophageal Voice Production

1968 ◽  
Vol 44 (1) ◽  
pp. 354-354
Author(s):  
Stanley J. Ewanowski ◽  
Thomas J. Hixon ◽  
Charles A. Kelsey ◽  
Fred D. Minifie
Keyword(s):  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Voice Production ◽  
Wall Movement

Assessment of Velar and Lateral Wall Movement by Oral Telescope and Radiographic Examination in Patients with Velopharyngeal Inadequacy and in Normal Subjects

1976 ◽  
Vol 41 (3) ◽  
pp. 381-389 ◽  
Author(s):  
Daniel H. Zwitman ◽  
Michael T. Gyepes ◽  
Paul H. Ward
Keyword(s):  
Cleft Palate ◽  
Wall Motion ◽  
Lateral Wall ◽  
Normal Subjects ◽  
Radiographic Examination ◽  
Craniofacial Anomalies ◽  
Wall Movement ◽  
Endoscopic Observation ◽  
Pharyngeal Flap ◽  
Lateral Walls

Thirty-one patients referred to the Craniofacial Anomalies Clinic for speech evaluation were evaluated by endoscopy and cineradiographic examination (lateral and submentovertical projection). Movement of the velar and lateral walls was examined by both procedures in order to determine the accuracy of the endoscopy in assessing velopharyngeal movement. Cineradiography confirmed endoscopic observation in a large percentage of patients. In a second study, lateral wall motion was assessed in 20 cleft palate patients with repaired hard and soft palate but with velopharyngeal inadequacy. Four categories of closure defined in a previous study on normal subjects were used to classify lateral wall movement in the cleft palate patients. Mesial lateral motion past the sides of the velum during phonation occurred less frequently in patients with velopharyngeal inadequacy than in persons with normal structures. The absence of lateral wall motion was observed more often in the cleft palate patients, although in over half of these patients the lateral walls moved mesially and filled Rosenmuller’s fossa (lateral recesses). Degree of lateral wall movement, which varies among cleft palate patients, should be estimated before construction of a prosthesis or pharyngeal flap in order to determine whether occlusion of the lateral gutters will occur during phonation.

What Muscle is Responsible for Lateral Pharyngeal Wall Movement?

1985 ◽  
Vol 14 (3) ◽  
pp. 224-227 ◽  
Author(s):  
Nobuhiko Isshiki ◽  
Yutaka Harita ◽  
Michio Kawano
Keyword(s):  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Wall Movement

Gross Unilateral Abnormalities of the Velum and Pharynx

2002 ◽  
Vol 39 (4) ◽  
pp. 461-468 ◽  
Author(s):  
Felicity V. Mehendale ◽  
Brian C. Sommerlad
Keyword(s):  
Facial Asymmetry ◽  
Normal Mucosa ◽  
Hemifacial Microsomia ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Velopharyngeal Incompetence ◽  
Good Improvement ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Abnormal Anatomy

Objective Velopharyngeal incompetence because of gross unilateral velopharyngeal hypoplasia is rare, particularly in patients with no significant hemifacial microsomia or facial asymmetry. We describe the abnormal anatomy and treatment of three patients with gross congenital velopharyngeal asymmetry. Results and Conclusions Following surgery, all three patients showed a good improvement in velopharyngeal function and speech. Nasendoscopy and lateral videofluoroscopy were important in confirming the abnormal anatomy and pathology and in evaluating the degree of movement of the affected side of the velum and pharyngeal walls as well as the size and location of the defect. Muscles from the normal side were radically dissected and mobilized across the midline to reconstruct the hypoplastic hemivelum. Mucosal lengthening was achieved by suturing the normal mucosa to the mucosa of the hypoplastic hemivelum and the lateral pharyngeal wall or by insetting a posterolateral pharyngeal flap (modified Moore pharyngoplasty) into the nasal surface of the hypoplastic side.

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