CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND ADULTS MSHA 2013 PABLO ANTONIO YSUNZA

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Presentation transcript:

CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND ADULTS MSHA 2013 PABLO ANTONIO YSUNZA

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) DiGEORGE SEQUENCE: NEURAL CREST DEFECT—THYMUS ABSENCE, HYPOCALCEMIA, IMMUNE DEFICIENCY

TERMINOLOGY SYNDROME: GROUP OF MALFORMATIONS WITH COMMON ETIOLOGY (VELOCARDIOFACIAL SYNDROME-22Q11.1 DELETION)

CLEFT PALATE PRIMARY PALATE SECONDARY PALATE

CLEFT PALATE

SUBMUCOUS CLEFT PALATE

V P I 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