Passavant's ridge during speech production with and without pharyngeal bulb.

The objective of this study was to investigate the occurrence of Passavant's ridge in patients with history of cleft palate presenting with velopharyngeal insufficiency (VPI) after primary palatal surgery. Twenty-five adult patients (mean age of 32 years), who wore a pharyngeal bulb prosthesis to correct VPI after primary palatoplasty participated in the study. Presence of Passavant's ridge was investigated in four conditions: prior to pharyngeal bulb for treatment of VPI (C1); during the molding of the pharyngeal bulb (C2); six months after the use of the pharyngeal bulb, but with the prosthesis removed (C3), and six months after the use of the pharyngeal bulb, but with the prosthesis in place (C4). Images of nasoendoscopic assessment of velopharyngeal function were obtained under all conditions were analyzed by speech-pathologists to identify the occurrence of Passavant's ridge during speech production. The results revealed a significant difference between molding condition (C2: 40%) and six months of bulb use (C4: 68%) (p = 0.028). The pharyngeal bulb may elicit the Passavant`s ridge in patients with history of cleft palate presenting with VPI.

Immediate and sustained changes in tongue movement with an experimental palatal "fistula": a case study.

OBJECTIVE: To determine the immediate and longer-term effect(s) on tongue movement following the placement of an experimental opening through a palatal obturator (replicate of subject's prosthesis) worn by an adult male with an unrepaired cleft of the hard and soft palate. METHODS: Tongue movements associated with an anterior experimental opening of 20 mm(2) were examined under three conditions: a control condition in which the subject wore the experimental obturator completely occluded, a condition immediately after drilling the experimental openings through the obturator, and a condition after 5 days in which the subject wore the experimental obturator with the experimental opening. An Electromagnetic Articulograph was used for obtaining tongue movements during speech. RESULTS: The findings partly revealed that the immediate introduction of a perturbation to the speech system (experimental fistula) had a temporary effect on tongue movement. After sustained perturbation (for 5 days), the system normalized (going back toward control condition's behavior). Perceptual data were consistent with kinematic tongue movement direction in most of the cases. CONCLUSIONS: Although the immediate response can be interpreted as indicative of the subject's attempts to move the tongue toward the opening to compensate for air loss, the findings following a sustained perturbation indicate that with time, other physiological adjustments (such as respiratory adjustments, for example) may help reestablish the requirements of a pressure-regulating system.