CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND...

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CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND ADULTS MSHA 2013 PABLO ANTONIO YSUNZA [email protected] du

Transcript of CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND...

Page 1: CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND ADULTS MSHA 2013 PABLO ANTONIO YSUNZA antonio.ysunza@beaumont.edu.

CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION

IN CHILDREN AND ADULTS

MSHA 2013PABLO ANTONIO YSUNZA

[email protected]

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TERMINOLOGY

• MALFORMATION: A LOCALIZED ERROR IN MORPHOGENESIS (CLEFT PALATE)

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TERMINOLOGY

• SEQUENCE: A MALFORMATION CAUSING ANOTHER MALFORMATION (S)

• PIERRE-ROBIN SEQUENCE: MICROGNATHIA—GLOSSOPTOSIS—SUB-TOTAL PALATAL CLEFT)

• DiGEORGE SEQUENCE: NEURAL CREST DEFECT—THYMUS ABSENCE, HYPOCALCEMIA, IMMUNE DEFICIENCY

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TERMINOLOGY

• SYNDROME: GROUP OF MALFORMATIONS WITH COMMON ETIOLOGY (VELOCARDIOFACIAL SYNDROME-22Q11.1 DELETION)

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CLEFT PALATE

• PRIMARY PALATE• SECONDARY PALATE

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CLEFT PALATE

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CLEFT PALATE

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SUBMUCOUS CLEFT PALATE

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SUBMUCOUS CLEFT PALATE

Page 10: CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF VELOPHARYNGEAL DYSFUNCTION IN CHILDREN AND ADULTS MSHA 2013 PABLO ANTONIO YSUNZA antonio.ysunza@beaumont.edu.

V P I

• W / COMPENSATORY ARTICULATION ERRORS (HYPERNASALITY AND ABERRANT PLACEMENT AND MANNER)

• WO / COMPENSATORY ARTICULATION ERRORS (HYPERNASALITY WITH APPROPRIATE PLACEMENT AND MANNER)

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V P I + COMPENSATORY ERRORS

• PROBLEM BEYOND V P S, INVOLVES ENTIRE VOCAL TRACT AND HIGHER LEVELS OF SPEECH PRODUCTION

• SPEECH THERAPY IS INDICATED• 1/3 OF RESIDUAL V P I SHOW

COMPENSATORY ERRORS• SURGERY DO NOT MODIFY COMPENSATORY

ERRORS

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VELOPHARYNGEAL SPHINCTER

• ANTERIOR: VELUM (LEVATOR VELI PALATINI AND MUSCULUS UVULAE)

• LATERAL: LATERAL PHARYNGEAL WALLS (SUPERIOR PHARYNGEAL CONSTRICTOR)

• POSTERIOR: POSTERIOR PHARYNGEAL WALL (SUPERIOR PHARYNGEAL CONSTRICTOR)

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VIDEOFLUOROSCOPY

• X-RAYS• DYNAMIC ASSESSMENT (VIDEO)• ANALYSIS ON VIDEO (DECREASE TOTAL

RADIATION TIME)• FRONTAL OR CORONAL, LATERAL OR

SAGGITAL, BASE OR AXIAL

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RESIDUAL V P I

• SYNDROMIC• NON SYNDROMIC

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NON-SYNDROMIC V P I

• INTRAVELAR VELOPLASTY (L V P SURGICAL REPAIR)

• FURLOW Z PLASTY• PHARYNGEAL FLAP• SPHINCTER PHARYNGOPLASTY