[The choice of method of surgical treatment of velopharyngeal insufficiency]. / Vybor metoda khirurgicheskogo lecheniya nebno-glotochnoi nedostatochnosti.

OBJECTIVE: To establish the criteria for selecting surgical treatments for velopharyngeal disfunction and to evaluate their effectiveness.Materials and Methods. 34 patients with velopharyngeal insufficiency underwent surgery at the National Medical Research Center for Surgery and Maxillofacial Surgery. Five common surgical methods for treating velopharyngeal disfunction were employed. RESULTS: The choice of surgery was primarily based on the anatomical and functional state of the muscle lifting the soft palate, specifically its position, which was determined visually or by MRI. Repositioning of the muscle helped to improve or restore speech in patients with velopharyngeal disfunction through surgeries such as secondary cleft revision, Furlow's palatoplasty, and triangular miomucosal flaps. In cases of soft palate palsy or correct positioning of the m. levator veli palatini, the focus of surgical treatment shifted to the pharynx, where surgeries like pharyngoplasty with a posterior pharyngeal flap and Hynes pharyngoplasties were performed. These also improved or restored speech in patients, though more towards improvement than complete restoration. If the muscle's position was optimal, the choice of treatment method subsequently depended on the results of additional nasopharyngoscopy: determining the size of the opening and the type of velopharyngeal closure. Besides the common methods used for speech management, various surgical procedures were combined based on the clinical situation. CONCLUSION: The position of the levator muscle is very important for its function. The optimal treatment for velopharyngeal disfunction, especially in patients with large openings, involved using a buccal flap alone or in combination with triangular mucosal-muscle flaps, where the highest percentage of normal speech rate was achieved.

[Universal scoring system for assessing speech function in patients with cleft palate at the stages of surgical treatment]. / Universal'naya ball'naya sistema otsenki rechevoi funktsii u patsientov s rasshchelinoi neba na etapakh khirurgicheskogo lecheniya.

OBJECTIVE: To develop a universal system for assessing the speech function in patients with congenital palatal cleft in the postoperative period. MATERIALS AND METHODS: A universal system for assessing the speech function for patients with a palatal cleft can be applied both after the primary operation of uranoplasty and for patients diagnosed with velopharyngeal insufficiency (VPI). The patient's speech is assessed according to the following criteria: defects in the pronunciation of consonants by place of articulation: labial, labiodental, lingual-dental, lingual-palatal, lingual-alveolar; speech breathing; tongue position; directed air stream; voicing disorders; The patient's is also evaluated for the following findings: hypernasality (reflected speech); hypernasality (spontaneous speech); hyponasality; pharyngeal reflex; audible nasal emission/turbulence; facial grimaces; speech intelligibility. The speech therapy and dental assessments are added to obtain a value characterizing the patient's condition: from 0 to 10 scoring indicates than only speech therapy correction is needed; from 11 to 18 - the decision on the necessity of surgical treatment is made by the surgeon together with the speech therapist, from 18 to 25 - surgical treatment is necessary with subsequent sessions with a speech therapist. RESULTS: With the help of this questionnaire, the operating surgeon can more accurately and objectively assess in dynamics the result of the surgical treatment, regardless of the results of speech therapy treatment in the postoperative period. The creation of this scoring system for speech assessment is aimed at objectivizing the results of uranoplasty and speech-improving operations. It allows the surgeon to compare the effectiveness of different surgical methods. CONCLUSION: The universal scoring system for assessing the state of speech function can be applied in the diagnosis of a patient with a palatal cleft both after the primary operation on the palate and after corrective surgical interventions. It allows monitoring progress and identifying dynamics in surgical and speech therapy treatment.