الملخص
RESUMEN La voz hipernasal y la regurgitación nasal son síntomas de disfunción velofaríngea. Ésta puede tener múltiples causas: anatómicas, neurológicas o funcionales. Se describe el caso de una paciente de sexo femenino, de 13 años, que se presenta con voz hipernasal y regurgitación nasal aguda. Al examen físico se evidencia inmovilidad del velo del paladar derecho sin otros hallazgos neurológicos. El estudio con resonancia nuclear magnética de cerebro y punción lumbar fueron normales. Se diagnosticó una incompetencia velofaríngea aguda transitoria, de probable etiología viral. La paciente evolucionó de forma favorable con mejoría clínica progresiva. La incompetencia velofaríngea a causa de una paresia o parálisis del nervio vago y/o nervio glosofaríngeo es una causa poco frecuente de disfunción velofaríngea.
ABSTRACT Hypernasal speech and nasal regurgitation are symptoms of velopharyngeal dysfunction. This may have multiple causes, including velopharyngeal incompetence due to paresis or paralysis of the vagus nerve and/or glossopharyngeal nerve. We describe the case of a 13 year-old female patient, with hypernasal speech and acute nasal regurgitation, with a physical examination showing immobility of the right palate with no other neurological findings. Magnetic resonance imaging of the brain and lumbar puncture was normal. Transient acute velopharyngeal incompetence was diagnosed, probably of viral etiology. The patient evolved favorably with progressive clinical improvement. Velopharyngeal incompetence due to paresis or paralysis of the vagus and/or glossopharyngeal nerves is a rare cause of velopharyngeal dysfunction.
الموضوعات
Humans , Female , Adolescent , Velopharyngeal Insufficiency/complications , Cranial Nerve Diseases/etiology , Palate, Soft , Speech Disorders/etiology , Velopharyngeal Insufficiency/diagnosis , Velopharyngeal Insufficiency/therapy , Nose Diseases/etiology , Velopharyngeal Sphincter/pathologyالملخص
Introdução: O retalho miomucoso de músculo bucinador, descrito em 1989, pode ser utilizado para corrigir fístulas palatinas, fissuras com alongamento do palato mole ou cobrir áreas cruentas após ressecções de tumores. Métodos: Trata-se da análise do resultado após 27 anos de 6 casos de pacientes operados no Hospital de Base e na Santa Casa de São José do Rio Preto, no período de 1984 a 1989, e reavaliados em 2016, nos quais foram realizados retalhos miomucosos de bucinador para correção de fissura palatina. Resultados: Dos 36 casos operados, 6 foram reavaliados após 27 anos, dos quais 5 trataram-se de correção primária e 1 de correção secundária (fístula após fechamento de fissura palatina). Todos os casos obtiveram resultados satisfatórios no crescimento maxilar, na correção da fistula palatina e na função da fala. Conclusão: Apesar de estatisticamente não significativo, o presente estudo demonstrou que o retalho miomucoso de músculo bucinador para correção e alongamento do palato é um procedimento adequado, com resultados de crescimento maxilar normal ou próximo disso e fala praticamente normal, mesmo sem adequado tratamento fonoaudiológico.
Introduction: The buccal musculo-mucosal patch, described in 1989, can be used to correct palatine fistulas and fissures with stretching of the soft palate, or to cover bloody areas after tumor resection. Methods: This is an analysis of the 27-year postoperative results for 6 patients who underwent operation at Base Hospital and Santa Casa de São José do Rio Preto between 1984 and 1989, and reassessed in 2016, when a myo-buccinator mucosa was used for cleft palate correction. Results: Of the 36 operated cases, 6 were reevaluated after 27 years, of which 5 had primary correction and 1 had a secondary correction (fistula after cleft palate closure). All the cases had satisfactory results in terms of maxillary growth, correction of the palatine fistula, and speech function. Conclusion: Although not statistically significant, the present study demonstrated that the buccal musculo-mucosal flap is an adequate procedure for correction and stretching of the palate, with normal or near-normal maxillary growth and practically normal speech even without adequate phono-audiological treatment.
الموضوعات
Humans , History, 21st Century , Palate, Soft , Surgical Flaps , Velopharyngeal Insufficiency , Cleft Lip , Cleft Palate , Oral Surgical Procedures , Fistula , Palate, Soft/anatomy & histology , Palate, Soft/abnormalities , Palate, Soft/surgery , Surgical Procedures, Operative/adverse effects , Surgical Flaps/surgery , Velopharyngeal Insufficiency/surgery , Velopharyngeal Insufficiency/complications , Velopharyngeal Insufficiency/rehabilitation , Cleft Lip/surgery , Cleft Lip/complications , Cleft Palate/surgery , Oral Surgical Procedures/methods , Fistula/surgery , Fistula/complications , Fistula/rehabilitationالملخص
Palatopharyngeal dysfunction may take place when palatopharyngeal valve is unable to perform its own closing due to a lack of tissue (palatopharyngeal insufficiency) or lack of proper movement (palatopharyngeal incompetence). Palatopharyngeal insufficiency induces nasal regurgitation of liquids, hypernasal speech, nasal escape, disarticulations and impaired speech intelligibility. Prosthetic management of palatopharyngeal insufficiency requires a close co-operation between an otolaryngologist and a speech pathologist. As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.
الموضوعات
Articulation Disorders/etiology , Cleft Palate/surgery , Humans , Male , Oroantral Fistula/rehabilitation , Palatal Obturators/psychology , Palate, Soft/pathology , Quality of Life , Respiratory Aspiration/etiology , Speech Disorders/etiology , Speech Intelligibility/physiology , Velopharyngeal Insufficiency/complications , Velopharyngeal Insufficiency/psychology , Voice Disorders/etiology , Young Adultالملخص
This article shows evidences that laryngeal and respiratory compensations due to poor velopharyngeal closure can develop vocal symptoms
الموضوعات
Humans , Child , Cleft Palate/etiology , Voice Disorders/diagnosis , Velopharyngeal Insufficiency/complications , Laryngeal Muscles/abnormalitiesالملخص
O presente estudo foi desenvolvido com a finalidade de identificar anormalidades da funçäo larígea em portadores de fissura de palato reparada com inadequaçäo velofaríngea. Foram determinados, por meio de um espirômetro, o fluxo médio fonatório (FMF) na produçäo mantida da vogal /a/ e o quociente fonatório (QF) na manobra da capacidade vital em 20 adultos fissurados e em um grupo controle de 20 adultos sem anormalidades vocais e laríngeas. Os valores de FMF e QF obtidos nos dois grupos näo diferiram estatisticamente entre si, mostrando que nos pacientes fissurados estudados, a inadequaçäo velofaríngea näo estava associada a disfunçöes laríngeas que pudessem ser identificadas pela metodologia utilizada