EPG research and therapy: further developments.

Electropalatography (EPG) has been used in the past 50 years for studying the patterns of contact between the tongue and the palate during speech production in typical speakers and those with speech disorders due to different causes. At the 7th EPG Symposium in Japan that was held online on 24 January 2021 (see: https://epg-research.sakura.ne.jp/), a panel of invited experts discussed their views regarding further developments and application of the technique. This paper provides a summary of this discussion. EPG offers information on articulation which cannot be replaced by other instrumental measures of speech. Identified areas for further hardware development are thinner EPG plates, better dental and palatal coverage, wireless connectivity, and sensors that provide additional articulatory information (e.g. tongue pressure, tongue-palate distance). EPG can serve as a resource for teaching speech disorders and phonetics. Furthermore, EPG therapy can be combined with telepractice in the speech therapy of clients with speech disorders.

Implications for the Multi-Disciplinary Management of Children With Craniofrontonasal Syndrome.

The purpose of this retrospective study was to assess the genetic and phenotypic features of patients with craniofrontonasal syndrome (CFNS), and the implications of the condition for multidisciplinary management.The subjects were 25 female patients with a mutation of EFNB1, who presented to the Oxford Craniofacial Unit during a 38-year period. Medical records were reviewed for genetic and phenotypic information. Mean duration of follow-up was 12.6 years (range 0-30.7 years).This study examines neurodevelopment in constituent parts, with specific reference to speech, language, and cognition in relation to genotype. Three children had deletions extending beyond the EFNB1 gene; the 2 with available data presented with speech, language, or cognitive delay. The remaining 25 patients had intragenic mutations of EFNB1. Of these 25, those assessed in detail showed variable difficulties with speech and language development; 57% had receptive language difficulties (n = 4/7) and 88% had expressive language difficulties (n = 8/9). 55% presented with speech difficulties (n = 6/11). 2/3 patients with abnormal hearing had speech difficulties; 4/5 with normal hearing had normal speech development. Cognitive assessments indicated that IQ is variable; with full scale IQ ranging from 69 to 100.The complex, multifactorial presentation of patients with CFNS contributed to 41% (n = 7/17) of patients requiring additional educational support.Our results demonstrated significant multidisciplinary input is required, including Speech and Language Therapy, Plastic and Reconstructive Surgery, Genetics, Ear, Nose and Throat, Maxillofacial, Orthodontic, Orthopaedic, Clinical Psychology and Orthoptic teams. The results of this study reinforce the importance of multi-disciplinary long-term follow-up of children with CFNS.

Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications.

OBJECTIVES: To summarize and discuss centre-level variation across a range of treatment and outcome measures and examine individual and ecological determinants of outcome in children in Cleft Care UK (CCUK). SETTING AND SAMPLE POPULATION: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK and treated within a centralized service. MATERIALS AND METHODS: Children had a range of treatment and outcome measures collected at a 5-year audit clinic. These outcomes included dento-alveolar arch relationships from study models, measures of facial appearance from cropped photographs, hearing loss from audiological assessment, speech from speech recordings, self-confidence and strengths and difficulties from parental self-report. Data were collected on educational attainment at age 7 using record linkage. Centre variation was examined using hierarchical regression and associations between variables were examined using logistic or poisson regression. RESULTS: There was centre-level variation for some treatments (early grommet placement, fitting of hearing aids, fluoride treatment, secondary speech surgery and treatment for cleft speech characteristics) and for some outcomes (intelligibility of speech). Hearing loss was associated with a higher risk of poor speech while speech therapy was associated with a lower risk of poor speech. Children had high levels of caries but levels of preventative treatment (fluoride varnish and tablets) were low. CONCLUSIONS: Further improvements to and monitoring of the current centralized model of care are required to ensure the best outcomes for all children with cleft lip and palate.

A Comparison of the Need for Speech Therapy After 2 Palatal Repair Techniques.

BACKGROUND: Reconstruction of the levator musculature during cleft palate repair has been suggested to be important in long-term speech outcomes. In this study, we compare the need for postoperative speech therapy between 2 intravelar veloplasty techniques. METHODS: Chart review was performed for patients with nonsyndromic cleft palate who underwent either primary Kriens or overlapping intravelar veloplasty before 18 months of age. All subjects completed a follow-up visit at approximately 3 years of age. Data obtained included documentation of ongoing or recommended speech therapy at age 3 years and reasons for speech therapy, which were categorized as cleft-related and non-cleft-related by a speech-language pathologist. RESULTS: One surgeon performed all Kriens procedures (n = 81), and the senior author performed all overlapping procedures (n = 25). Mean age at surgery (Kriens = 13.5 ± 1.4 months; overlapping = 13.1 ± 1.5 months; P = 0.188) and age at 3-year follow-up (Kriens = 3.0 ± 0.5 years; overlapping = 2.8 ± 0.5 years; P = 0.148) were equivalent in both groups. Cleft severity by Veau classification (P = 0.626), prepalatoplasty pure tone averages, (P = 0.237), pure tone averages at 3-year follow-up (P = 0.636), and incidence of prematurity (P = 0.190) were also similar between the 2 groups. At 3 years of age, significantly fewer overlapping intravelar veloplasty patients required cleft-related speech therapy (Kriens = 47%; overlapping = 20%; P = 0.015). The proportions of patients requiring non-cleft-related speech therapy were equivalent (P = 0.906). CONCLUSIONS: At 3 years of age, patients who received overlapping intravelar veloplasty were significantly less likely to need cleft-related speech therapy compared with patients who received Kriens intravelar veloplasty. Cleft severity, hearing loss, and prematurity at birth did not appear to explain the difference found in need for speech therapy.

Adult Quality of Life Post Cleft Palate Repair: A Comparison of Two Techniques.

BACKGROUND AND PURPOSE: In 1989, the Cleft Palate-Craniofacial Journal published the first randomized prospective cleft surgery study, comparing the Kriens intravelar veloplasty (IVV) with a non-IVV 2-flap repair. Results in that and follow-up publications yielded no difference between the 2 groups for need for secondary velopharyngeal management. The subjects have now reached adulthood. This study was designed to ask: Is there any difference between the groups in the outcomes that multidisciplinary team care addresses: speech intelligibility, facial growth, breathing while awake and asleep, attainment of education, and long-term socioeconomic status? METHODS: Enrollees from the original published study were invited to participate in a survey. Subjects responded to questions about speech therapy and speech satisfaction, additional surgery, breathing patterns, sleep quality/sleep disorder, and dental occlusion. Demographic information, information on education level, profession, and socio-economic status were queried. Student t test and Fisher exact test were used to compare results. RESULTS: Forty-two of the original 200 patients (20 Kriens IVV and 19 non-IVV) chose to participate. Average age at survey was 25 ±â€Š3 years. Analysis yielded no difference between the 2 respondent groups for need for secondary velopharyngeal management. There were no differences in speech outcome and satisfaction (8 questions, 0.30 < P < 0.97), sleep concerns (3 questions, 0.16 < P < 0.39), and dental occlusion (P = 0.69). Equivalent proportions of the 2 groups had been in speech therapy (P = 0.22). There was no difference in education attainment of the 2 groups (P = 0.26). CONCLUSIONS: The original randomized prospective trial suggested that there was no difference between the 2 surgery types in need for secondary velopharyngeal management. This long-term survey study on the same group of patients suggests that in young adulthood, the 2 groups have similar outcomes in terms of education, career choice, speech satisfaction, dental occlusion, and sleep disorder.

Keep an Eye Out for the Bifid Uvula: A Case Report.

The incidence of submucous cleft palate is between 1:1250-1:6000. It is important for this relatively silent deformity to be identified early and referred appropriately as a delay in diagnosis may affect the patient's quality of speech in the long-term. This paper presents a case of submucous cleft palate which was diagnosed late (age 14). Nevertheless, by the appropriate intervention of the multidisciplinary cleft team, the patient was treated successfully. Clinical Relevance. Dentists and doctors need to be aware of the signs and symptoms associated with submucous cleft palate so that they can refer the patient to an appropriate specialist centre for further investigation and treatment. Moreover, patients with this condition are shown to have a higher incidence of dental abnormalities, such as hypodontia and peg-shaped laterals.

A model for interprofessional health care: lessons learned from craniofacial teams.

Seventy-six years ago, Herbert K. Cooper, DDS, DSc, LHD, FACD, created the first interprofessional health care team in response to the frequency of craniofacial anomalies and related speech and hearing deficits in Lancaster, Pa. His experiences and those from subsequent "medical-dental-nursing-pharmacy allied health professions" craniofacial teams inform and provide "best practices" for the future of interprofessional education. This paper revisits the genesis of craniofacial teams and highlights successes, challenges and cost benefits applicable today.

The nance obturator, a new fixed obturator for patients with cleft palate and fistula.

In patients with fistulas that impair function (e.g., feeding, resonance, intelligibility), obturators are used to improve feeding and reduce nasal air emission by occluding the abnormal opening between the oral and nasal cavities. This report describes a novel method for occluding an anterior palatal fistula in patients with cleft palates. The new design for a fixed obturator is based on the Nance appliance, which was originally used as a space maintainer, but has been redesigned for closing an anterior palatal fistula in a patient with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful. As it is a fixed device, it does not require remaking with maxillary growth. The new design may also function as a fixed space maintainer to preserve molar anchorage and maxillary transverse width.

Hyrax application as a tooth-borne distractor for maxillary advancement.

Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the use of internal DO in the treatment of maxillary hypoplasia in a patient with cleft lip and palate. The case illustrates a 17-year-old boy with class III malocclusion, maxillary deficiency, and cleft lip and palate. Because the patient was experiencing severe hypernasality, it was decided to treat him by DO. The treatment process began by mounting a hyrax in the upper jaw for lateral expansion. A second hyrax was mounted in a way to create anteroposterior expansion. One day after the second hyrax application, the patient underwent a modified Le Fort I osteotomy. He was instructed to turn the screws twice per day for 12 days. The treatment was continued by means of a conventional face mask for 2 months. After 16 months of active treatment, favorable correction of the skeletal problem was observed. The S-N-A angle increased by 5 degrees, and patient's hypernasality was comprehensively improved.

Speech outcome following late primary palate repair.

OBJECTIVE: Early palate repair is recommended to minimize the development of disordered speech. We studied the speech outcome of late palate repair in 131 patients. The success of late palate repair is questioned because of the persistence of learned, compensatory misarticulations that are difficult to correct in spite of the establishment of correct palatal anatomy and a competent velopharyngeal mechanism. The objective of this study is to highlight the speech results following late primary repair of the palate. SETTINGS AND DESIGN: Retrospective analysis of speech outcomes in 131 patients with cleft lip and palate who underwent primary palate repair after the age of 10 years between November 2000 and December 2004. None of the patients had received supervised institution-based speech therapy. However, all patients were counseled and oriented and demonstrated the correct place and manner of articulation for the phonemes misarticulated by them. Preoperative and 6- to 12-month postoperative speech samples were assessed within the parameters of articulation, hypernasality, nasal air emission, and speech intelligibility. OUTCOME: The analysis indicated improvement in all speech parameters leading to an overall improvement in postoperative intelligibility for most patients. CONCLUSION: Although definite improvement occurs in all parameters of speech following late primary palate repair, residual speech problems persist in most patients, requiring further evaluation and appropriate treatment.

Management of velopharyngeal disorders. A case series.

Patients with acquired defects or congenital malformations of the palate exhibit disturbances in speech, including hypernasality, nasal emission, and decreased intelligibility of speech. Maxillofacial prosthetic treatment can reestablish the palatopharyngeal integrity to provide the potential for acceptable speech. This article describes a case series of patients with palatopharyngeal disorders and their treatment approaches.

Speech evaluation after repair of unilateral complete cleft palate using modified 2-flap palatoplasty.

UNLABELLED: Two-flap palatoplasty using mucoperiosteal flaps is becoming popular for wide cleft palates. We found that elevation of the cleft-side mucoperiosteal flap was sufficient to close the defect without elevation or relaxing incision in the noncleft side when performing 2-flap palatoplasty for a complete unilateral cleft palate. We have termed this modified 2-flap palatoplasty. The present study compared speech after classic and modified 2-flap palatoplasty for unilateral complete cleft palate. METHODS: Of 31 unilateral complete cleft lip and palate patients, 16 underwent the classic 2-flap palatoplasty between September 1998 and September 2000, and 15 underwent modified 2-flap palatoplasty between November 2000 and November 2002. Postoperative speech evaluation was undertaken by a speech pathologist. Patients with functional speech problems such as hypernasality or compensatory articulation were recommended for speech therapy. In cases where speech therapy did not result in normal speech, patients underwent secondary velopharyngeal surgery and further speech therapy. RESULTS: Fifteen of 16 patients who underwent the classic procedure were followed up, of which 5 showed hypernasality or compensatory articulation upon speech evaluation. Four of those patients required secondary velopharyngeal surgery. All 15 patients who underwent the modified procedure were followed up. Six of those patients showed hypernasality or compensatory articulation, of which 2 required secondary velopharyngeal surgery. There was no statistically significant difference between the classic and modified groups in terms of palatal fistula rate, speech, and secondary surgery rate. CONCLUSIONS: There was no difference between the classic and modified 2-flap palatoplasty in terms of postoperative palatal fistula rate, speech, and secondary surgery rate. Because of the advantages of the modified procedure in terms of fewer incisions, these findings indicate that larger long-term studies are warranted, particularly to evaluate maxillary bone growth.

Moebius syndrome: clinical manifestations in a pediatric patient.

Moebius syndrome is a congenital, nonprogressive disorder clinically characterized by loss of facial expression, impaired stomatognathic system functions, incapacity to close the eyelids, and several oral impairments. The purpose of this paper was to present the clinical manifestations and the dental treatment in a 5-year, 2-month-old male Moebius syndrome patient. The child presented with facial asymmetry, difficulty performing facial mimic movements and pronouncing some letters, and compromised suction, mastication, breathing, and deglutition. An intraoral examination revealed hypofunction of the perioral muscles, cheeks and tongue, ankyloglossia, anterior open bite, and absence of carious lesions and dental anomalies. The dental treatment consisted of frenectomy and further placement of a removable orthodontic appliance with a palatal crib for correction of the anterior open bite. After 12 months of follow-up, anterior open bite decreased and speech, deglutition, and mastication improved.

Apraxia of speech and language delay: the complexity of diagnosis and treatment of symptomatic children. / Apraxia de fala e atraso de linguagem: a complexidade do diagnóstico e tratamento em quadros sintomáticos de crianças.

Apraxia of speech is defined as the inability to sequence the movements required for accurate articulatory production, traditionally involving a deficit in speech motor programming. Language clinicians often confront about speech inconsistency clinical cases, which raise questions concerning the differential diagnosis between apraxia and language disorders. Such problem often results in the difficulty to establish an adequate treatment decision. In this work, we discuss a clinical report in which both diagnosis and treatment raise questions about the apraxic speech condition in childhood. We start from the recognition that, in apraxia, it seems imperative to consider that the body to be considered is the one that surpasses its organic functions and structure. Clinical consequences are drawn from the premise that the human body is one whose ear can listen, and mouth can speak, i.e., the organic structure is a material realm open to the incidence of language and its "music", which creates the speaking body.

Define-se apraxia de fala como a inabilidade de sequenciar os movimentos necessários a uma produção articulatória acurada, cuja explicação, tradicionalmente, é remetida a um déficit na programação motora da fala. Não é infrequente que clínicos de linguagem se defrontem com casos clínicos em que a inconsistência da fala coloca questões quanto ao diagnóstico diferencial entre apraxia e quadros considerados de linguagem. O reflexo desse impasse é observado na dificuldade em estabelecer uma direção de tratamento adequada ao problema apresentado. Neste trabalho, apresentamos o relato de um caso clínico em que tanto o diagnóstico quanto o tratamento mobilizam discussões a respeito da condição apráxica de fala na infância. Nas apraxias, partimos do reconhecimento de que o corpo colocado em evidência é aquele que ultrapassa sua configuração puramente orgânica. Consequências clínicas são retiradas da premissa de que o corpo humano é aquele cuja orelha pode escutar e a boca, falar, ou seja, é estrutura orgânica posta a funcionar de maneira especial pela incidência da música da linguagem a invocar o corpo falante.

Combined orthodontic-orthopedic approach: a second choice in some surgical cases.

The present case involves the treatment of a 21-year-old speech therapy student presenting a severe Class II/I occlusion with marked oral dysfunction handicapping her profession. In addition to a multibond appliance, the following orthopedic adjuncts were used sequentially: cervical headgear, a bimaxillary functional appliance (Biopart), a provisional occlusal plane, and composite reshaping of canine crowns. The survey of 8 years after recovery suggests that this technique is a viable alternative when patients do not opt for surgery.

Reconstruction of the soft palate in oral cancer to repair an operative defect with speech aid prosthesis: a case report.

A soft palate defect may result from surgical resection, and its consequences could include hypernasal speech and nasal regurgitation of food and liquids. A speech aid prosthesis fabricated for patients can improve nasal emission during speech, and assist in preventing nasal regurgitation of food. This article presents a case of the reconstruction of a soft palate defect by prosthetic obturation.

Prosthodontic Management of Palatopharyngeal Incompetency - A Case Report on Palatal Lift Prosthesis.

The palatal lift prostheses (PLP) are commonly used in the prosthetic management of palatopharyngeal incompetency. These prostheses work by lifting the soft palate upward and backward and also have physical and psychological benefits. In this case report, a PLPwas provided to the patient for her speech problems. The soft palate was mechanically lifted upward and backward. PLPreduced the diameter of palatopharyngeal sphincter. This decreased the dysarthria and led to an increase in patient confidence. Surgically repaired cleft palate of this patient with hyper-nasality was successfully managed with PLP. It was concluded that PLP is acceptable and effective in the prosthodontic management of palatopharyngeal incompetency.

Patients' perception of improvement after orthognathic surgery: pilot study.

We aimed to find out what patients thought of their quality of life after they had had an orthognathic operation. Thirty-two patients returned three questionnaires and 15 were further interrogated by telephone. Preoperatively the patients mentioned mainly functional problems as a reason for asking for the operation, but expectation of aesthetic improvement was also an important factor. They were generally satisfied with the outcome of the operation. Postoperative improvement was mentioned in terms of chewing, appearance, headaches, and bullying. Patients felt more secure in company with other people postoperatively. We conclude that patients' perceptions after orthognathic operations were generally favourable but there is a need for improved information to patients during the treatment.

Fabrication of a meatus obturator on a titanium framework with a 1-step impression.

The fabrication of meatal obturator prosthesis with titanium framework using a 1-step final impression procedure is described in the case of a 44-year-old woman with congenital absence of the soft palate. The meatus obturator results in a more stable maxillary prosthesis and permits acceptable speech for a patient with total absence of the soft palate. The fabrication technique is relatively easy and saves time by eliminating some laboratory procedures.

[What are management practices for speech therapy in amyotrophic lateral sclerosis?]. / Quelles sont les modalités de la prise en charge orthophonique dans la Sclérose Latérale Amyotrophique?

Amyotrophic lateral sclerosis involves deterioration of speech and swallowing. The objectives of rehabilitation are to maintain a comprehensible speech, using exercises on airflow-phonic coordination and breath, lingual and labial movements. Rehabilitation exercises also focus on the different times of swallowing to improve management of the food bolus in the mouth, to learn facilitating techniques and to adopt postures favoring passage of the food bolus. No studies have addressed the question of the effectiveness of rehabilitation in amyotrophic lateral sclerosis, in term of quality of life, maintenance of comprehensible speech or reduction of respiratory risks. Rehabilitation programs are established on an individual basis according to the clinical presentation and course.