Outcomes of Palatal Lift Prosthesis on Dysarthric Speech.

PURPOSE: This study was designed to investigate the effect of palatal lift prosthesis (PLP) on the speech of individuals with different types of dysarthria. PARTICIPANTS: Thirty (19 males and 11 females) native speakers of Jordanian Arabic with dysarthria participated in the study. The age of the participants ranged from 8 to 67 years with an average of 34.1 years. Traumatic brain injury was the most common etiology of dysarthria among 12 participants, stroke among 11, multiple sclerosis among 3, and pseudobulbar palsy among 2; 1 participant had Parkinson disease, and another participant had amyotrophic lateral sclerosis. METHODS: Five acoustic and aerodynamic measures were evaluated to determine the speech outcomes including nasalance scores, sequential motion rate, speech rate, vital capacity, and sound pressure level. The acoustic measures were obtained from the participants in PLP-out and PLP-in conditions. RESULTS: Results showed statistically significant decrease in the nasalance scores of the syllable repetition, vowel prolongation, and sentence repetition tasks in the PLP-in condition below the 28% cutoff score. Furthermore, results revealed statistically significant increase in sequential motion rate, speech rate, vital capacity, and sound pressure level (P = 0.000). CONCLUSION: The use of PLP is an effective treatment option of dysarthric speech. Besides nasalance scores, the sequential motion rate, speech rate, vital capacity, and sound pressure level are considered reliable speech measures that may be used to evaluate the effect of PLP on dysarthria.

A case of symmetrical lipomatosis of the tongue presenting as macroglossia.

UNLABELLED: Lipomas are the most common benign soft tissue mesenchymal tumours composed of mature adipose tissue. They are uncommon in the oral and maxillofacial regions, with 15-20 % of cases involving the head and neck region and less than 5% of all benign oral lesions. Multiple symmetric lipomatosis is rare and characterized by diffuse growth and nonencapsulated lipomas. It is usually found in the posterior neck and upper trunk and they are relatively infrequent on the oral and maxillofacial regions like Madelung disease. In the report, we describe a rare case of symmetrical lipomatosis of tongue with OSAS and Dysartria. This lesions were resected under general anesthesia. Intraoperative findings revealed only adipose tissues with replacement of lingual muscles and no capsulation. The lesion was finally diagnosed as symmetric lipomatosis of the tongue based on clinical radiological and histologic examination. SLT (Symmetrical lipomatosis of the tongue) is an extremely rare case that appears like a macroglossia. Partial glossectomy is the treatment of choice because of the improvement of symptoms and the low rate of recurrence. KEY WORDS: Macroglossia, Oral lipoma, Tongue lipomatosis.

Growing dissecting aneurysm of basilar trunk treated with stent-assisted coiling.

Growing basilar dissecting aneurysm is a scarce but increasingly recognized entity, accounting for a significant risk of death and disability. Controversy exists regarding the optimal management. A 61-year-old man presented with dysarthria and left hemiparesis attributable to a basilar trunk dissecting aneurysm. Antiplatelet therapy was instituted, and the patient's clinical condition markedly improved. However, he developed severe headache, dysarthria, and left hemiparesis 35 days later. Angiography revealed significant enlargement of the aneurysm, and stent-assisted coiling was then uneventfully performed. The patient remained clinically stable with only mild left-sided hemiparesis at the 2-year clinical follow-up.

Acute functional reactivation of the language network during awake intraoperative brain mapping.

Acute brain plasticity during resection of central lesions has been recently described. In the cases reported, perilesional latent networks, useful to preserve the neurological functions, were detected in asymptomatic patients. In this paper, we presented a case of acute functional reactivation (AFR) of the language network in a symptomatic patient. Tumor resection allowed to acutely restore the neurological deficit. Intraoperative direct cortical stimulation (DCS) and functional neuroimaging showed new epicentres of activation of the language network after tumor excision. DCS in awake surgery is mandatory to reveal AFR needful to improve the extent of resection preserving the quality of life.

[Treatment of facial paralysis with temporalis lengthening myoplasty and dysarthria improvement]. / Myoplastie d'allongement du temporal et amélioration de la dysarthrie des patients paralysés faciaux.

INTRODUCTION: The dysfunctions engendered by the peripheral facial paralysis (PFP) induce modifications of the verbal and para-verbal functions. The purpose of our study was to observe if the temporalis lengthening myoplasty (TLM) allowed to decrease dysarthria observed on the operated patients. MATERIALS AND METHODS: We followed-up seven patients affected by a peripheral facial paralysis with various etiologies. Due to specifics needs of this study, we created an evaluation grid of the articulation, which allowed us to measure evolutions after the operation by a tri-phase evaluation: before surgery, at 3 and 6months after it. RESULTS: Results show a definite improvement of dysarthria in the whole test group. CONCLUSION: TLM operation, in addition to be very efficient for the recovering of the paralyzed side, can also treat dysarthria on these patients.

[Dysphagia and dysarthria surgery for advanced-age myasthenia gravis].

Myasthenia gravis is often difficult to diagnose and treat in older subjects due to complications, previous history and reciprocal interaction with drugs used to treat complications. An 84-year-old woman with slowly progressive 2-year dysphagia and dysarthria had reached critical condition with aspiration pneumonia. She was diagnosed with thymoma-free myasthenia gravis and her respirator removed after being administrated an anticholinesterase drug. Her dysphagia and dysarthria did not improve. Because of severe osteoporosis with two previous lumbar compression fractures and excessive thinness, she could not be given prednisolone or immunosuppressive drugs. Following cricopharyngeal myotomy and bilateral lateral palatopharyngeal wall narrowing, she could eat without misdeglutition and speak clearly.

Giant cell arteritis presenting as dysarthria and mediastinal mass.

Giant cell arteritis, Takayasu arteritis, and Horton disease are rare, idiopathic diseases that cause chronic inflammation and obliteration of large arteries, mainly the aorta and its major branches. Histological examination reveals multinucleated giants cells and clinical presentation is characterized by general symptoms and/or symptoms related to stenosis or occlusion of vessels. A case of a 50-year-old woman with neurological symptoms, cervicothoracic tumour with severe stenosis of the right subclavian artery and complete occlusion of common carotid artery is presented.

Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome.

OBJECT: The authors conducted a study to evaluate the unique presenting signs and symptoms of Chiari malformation Type I (CM-I) in children younger than 6 years of age and highlight the benefits of early surgical treatment in this patient population. METHODS: The authors reviewed the medical records of patients who presented to the neurosurgery department before their 6th birthday and subsequently underwent surgery for CM-I. They identified 39 patients who had been evaluated between 1984 and 2007 and examined the medical records for presentation, surgical intervention, and outcome. RESULTS: Children aged 0-2 years commonly presented with oropharyngeal dysfunction (77.8%). Children aged 3-5 years more frequently presented with syringomyelia (85.7%), scoliosis (38.1%), and/or headache (57.1%). All patients underwent posterior fossa craniectomy. Additionally, in many patients cervical laminectomy and/or duraplasty was performed. A few patients required transoral decompression and occipitocervical fusion. In most cases, surgery led to resolution or dramatic improvement of initial symptoms. CONCLUSIONS: Early recognition and surgical treatment of CM-I in young children leads to good outcomes in the majority of patients. Additional therapies for oropharyngeal dysfunction, syringomyelia, and scoliosis can frequently be avoided.

Outcomes of type II thyroplasty for adductor spasmodic dysphonia: analysis of revision and unsatisfactory cases.

CONCLUSION: The factors responsible for the observed failures can be broken into two major groups: (1) a wrong indication and (2) an inadequate technique to achieve relief from an excessively tight glottal closure. The use of a titanium bridge in place of a silicone shim was found to be essential. Type II thyroplasty can relieve the symptoms of adductor spasmodic dysphonia (AdSD) when implemented with a modern technique using titanium bridges. OBJECTIVES: To identify the factor or factors that necessitated revision surgery in type II thyroplasty for AdSD, detailed analytical examinations were made of individual cases with unsatisfactory outcomes. PATIENTS AND METHODS: A retrospective analysis of a case series with follow-up periods of 2-5 years. RESULTS: Ninety AdSD patients underwent type II thyroplasty. The results in one patient were limited because a pathological mechanism other than AdSD was also involved. One patient, a singer, who wanted a more intense voice for singing was dissatisfied with the results. In three patients, the material used for fixation was inadequate. In two other patients, the method of application of the fixative material was found to be insufficient as it did not include both the upper and lower sides.

Mutismo cerebeloso grave tras cirugía de un tumor de fosa posterior / Severe cerebellar mutism after posterior fossa tumor resection

El mutismo cerebeloso es una complicación infrecuente pero con gran trascendencia en los niños intervenidos de cirugía de fosa posterior. Disartria, irritabilidad y ataxia, son parte de sus síntomas y signos, que suelen ser leves y autolimitados, pero en algunos casos graves, pueden alterarse funciones cognitivas superiores, pudiendo verse comprometidas las relaciones personales y sociales futuras del niño. Está descrito en otras situaciones, por lo que es importante para el pediatra el conocimiento de sus síntomas, fisiopatología, diagnóstico, grados de severidad y enfoque terapéutico, así como su pronóstico, dado que requiere de un tratamiento multidisciplinario. Presentamos el caso clínico de un niño de 5 años intervenido de un ependimoma de bajo grado localizado en el cuarto ventrículo, que desarrolló 48 h después de la resección quirúrgica, un cuadro consistente en mutismo, irritabilidad, afectación de pares craneales y movimientos estereotipados, en el contexto de una hidrocefalia activa. La clínica del paciente mejoró progresivamente a partir de 1,5 mes tras la intervención. Revisamos la bibliografía existente sobre el mutismo cerebeloso y discutimos su fisiopatología, que parece confirmar que el cerebelo no participa únicamente como un simple coordinador de la función motora, sino que desempeña un papel relevante en funciones cognitivas superiores, como el lenguaje

Cerebellar mutism is an infrequent but important complication after posterior fossa surgery in children. Dysarthria, irritability and ataxia are among the signs and symptoms of this disorder, which are usually mild and self-limiting. However, in severe cases, there can be impairment of higher-level cognitive functions, affecting the child's future personal and social relations. This disorder has been described in many other situations and consequently pediatricians should be familiar with its symptoms, physiopathology, diagnosis, degrees of severity, treatment, and prognosis, since a multidisciplinary approach is required. We present the case of a 5-year-old boy who underwent surgery for a low-grade ependymoma in the fourth ventricle; 48 hours after surgical resection, the boy developed irritability, cranial nerve involvement and stereotyped movements in the context of active hydrocephalus. His symptoms progressively improved 6 weeks after the intervention. We review the literature on cerebellar mutism and discuss the physiopathology of this disorder, which seems to confirm that the cerebellum not only acts as a simple coordinator of motor function, but also plays an important role in higher-level cognitive functions, such as language

[Tongue mobility in ankyloglossia with regard to articulation]. / Poglady na temat ruchomosci jfizyka w ankyloglosji a potrzeby artykulacyjne.

A sound is created as a result of several breathing, phonetic and articulation positions and movements which take place in the articulation system consisting of both mobile and immobile elements. The tongue is one of the mobile elements of the articulation system. Full range of tongue mobility is required to form sounds correctly. If mobility of the tongue is reduced, sounds may slightly, moderately or highly deviate from proper ones. Serious deviations in articulate structure of sounds (such as non-vibrating front part of the tongue in the /r/ phoneme) are easy to notice since they change phoneme structure of the sound. Slight deviations (e.g. non-vibrational or non-mediumistic action of the tongue) may be unnoticed because speech is still comprehensible although it is formed with compensatory positions and movements of breathing, phonetic and articulation apparatus. There are some phonemes that require a wide range of tongue mobility to be formed correctly, while others require less tongue mobility. In the Polish language, phonemes that require the most mobile tongue are: trembling /r/, lateral /l/, humming /sz, z, cz, dz/, and soft /i, j, s, z, c, dz/. In order to diagnose abnormalities, organs of speech need to be observed directly (photographs, films) or indirectly (videoradiography). One of the factors that restrict (to a slight, average or high degree) tongue mobility is the short frenulum. According to the general opinion "the tongue frenulum has no influence on tongue mobility". However, persons with ankyloglossia form at least one of the above-mentioned phonemes incorrectly to a slight, medium or high degree and frenotomy is required to make improvement of speech by a speech therapist effective. In opinion of many physicians and speech therapists " frenotomy is usually pointless because a new scar is formed that makes the frenulum even shorter than before". I have found in my research that tongue mobility improves after each frenotomy and no adhesions are formed after simple horizontal cutting of the frenulum with scissors (local anesthesia) if the wound is not sutured. It is often necessary to carry out several frenotomies to achieve full articulating mobility of the tongue.

Acoustic voice assessment in Parkinson's disease patients submitted to posteroventral pallidotomy.

UNLABELLED: Long-term complications in levodopa treated Parkinson's disease (PD) patients caused a resurgence of interest in pallidotomy as an option of treatment. However, postoperative complications such as speech disorders can occur. PURPOSE: The aim of this study is to evaluate the acoustic voice in PD patients, before and after posteroventral pallidotomy. METHOD: Twelve patients with PD were submitted to neurological and voice assessments during the off and on phases, in the pre-operative, 1st and 3rd post-operative months. The patients were evaluated with the UPDRS and the vocal acoustic parameters -- f0, NHR, jitter, PPQ, Shimmer, APQ (using the software MultiSpeech-Kay Elemetrics-3700). RESULTS: The off phase UPDRS scores revealed a tendency to improvement at the 1st month and the off phase worsened. The shimmer and APQ improved. CONCLUSION: This study shows that pallidotomy has little improvement on functional use of communication of PD patients.

Acoustic voice assessment in Parkinson's disease patients submitted to posteroventral pallidotomy

O uso prolongado da levodopa na doença de Parkinson (DP) pode ocasionar alterações em seu rendimento e possibilitou o interesse no ressurgimento da palidotomia. Contudo, complicações pós-operatórias podem ocorrer. OBJETIVO: O presente estudo tem por objetivo avaliar alguns parâmetros acústicos da voz de pacientes com DP pré e pós a realização da palidotomia posteroventral METODO: foram avaliados 12 pacientes com PD submetidos a avaliação neurológica e da voz durante as fases off e on do uso da levodopa, nos momentos pré-operatório, no primeiro e no terceiro mês pós-operatório. Os pacientes foram avaliados com base na escala UPDRS - item motor - e por meio dos parâmetros acústicos da voz - f0, NHR, jitter, PPQ, Shimmer, APQ (usando o software MDVP - Kay Elemetrics - 3700). RESULTADOS: Na fase off o escore UPDRS revelou tendência de melhora no 1º pós-operatório e na fase on piora. Os parâmetros acústicos shimmer e APQ apresentaram melhora. CONCLUSÃO: Este estudo mostrou que a palidotomia resulta em discreta melhora no uso funcional da comunicação dos pacientes com DP.

Speech arrest as first symptom of a tumour in the supplementary motor area.

There are only few reports in the literature on isolated episodes of speech arrest as first symptom of a tumour in the supplementary motor area. These episodes of speech arrest are due to seizure activity and must be distinguished from speech arrest due to transient ischaemic attacks. The diagnosis may be difficult because the tumour may erroneously be suspected in the lower portion of the sensorimotor strip and may, hence, be missed on CT if apical sections of the regions are not performed. Clinical and experimental aspects of this problem are discussed on the basis of a case report and a review of the literature.

The role of pharyngoplasty in congenital neurogenic speech disorders.

Children with dysarthria are often seriously handicapped by their inability to communicate. Velopharyngeal incompetence may contribute to their speech difficulties but the indications for pharyngoplasty are poorly defined. The speech of 41 children, thought to have a defect of neurological origin and referred for possible pharyngoplasty, was assessed by a speech therapist, by nasopharyngoscopy and by multiview videofluoroscopy. These investigations revealed that 16 had velopharyngeal incompetence, with a neurological aetiology, and might be expected to benefit from pharyngoplasty. Independent assessment of the intelligibility of these 16 children before and after pharyngoplasty has been related to their preoperative oropharyngeal function. The majority benefited from surgery, some substantially. In particular, good lip and tongue function are shown to be necessary to achieve improved intelligibility. The roles of age, intelligence and aetiology in the success of pharyngoplasty are discussed.