title: Velopharyngeal incompetence in patients with cleft palate, flexible video pharyngoscopy and perceptual speech assessment: a correlational pilot study.
abstract: OBJECTIVE
  To assess the role of video endoscopy in evaluating velopharyngeal incompetence and investigate a possible relationship between velopharyngeal incompetence type and speech defect in cleft palate patients.
  
  
  METHODS
  A prospective study of 28 pre- or post-operative cleft palate patients with speech defects who attended Plastic Surgery-Cleft Palate and ENT out-patient clinics was performed. The velar defect type was determined using a flexible endoscope and findings were video recorded. Speech pathology was assessed using the cleft palate audit protocol for speech.
  
  
  RESULTS
  A significant, clinically relevant relationship was noted between the perceived characteristics of hypernasality and velopharyngeal insufficiency type. Hypernasal speech was a definite clinical indicator of velopharyngeal incompetence, and the type 1 velopharyngeal defect was most common. Type 1 velopharyngeal coronal-type dysfunction was strongly associated with hypernasality (p < 0.05). When speech substitution was noted, type 2 velopharyngeal (or sagittal) incompetence could be predicted (p < 0.05).
  
  
  CONCLUSIONS
  In the management of cleft palate patients, it is important that surgical correction of the defect and achieving velopharyngeal competency for speech are performed simultaneously. Pre-operative velopharyngeal endoscopy with speech assessment will define the anatomical and functional bases for velopharyngeal correction and assist in planning and tailoring the pharyngeal flap.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery,Christian Medical College,Vellore, Tamil Nadu,India.
authors.forename: S
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery,Christian Medical College,Vellore, Tamil Nadu,India.
authors.forename: M
authors.initials: M
authors.lastname: Kurien
authors.affiliation: Department of Plastic Surgery,Christian Medical College,Vellore, Tamil Nadu,India.
authors.forename: A K
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery,Christian Medical College,Vellore, Tamil Nadu,India.
authors.forename: S S
authors.initials: SS
authors.lastname: Mathews
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery,Christian Medical College,Vellore, Tamil Nadu,India.
authors.forename: R R
authors.initials: RR
authors.lastname: Albert
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery,Christian Medical College,Vellore, Tamil Nadu,India.
authors.forename: D
authors.initials: D
authors.lastname: Tychicus
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D019937:Diagnostic Techniques and Procedures; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010614:Pharynx / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D013060:Speech / Q000502:physiology*; D013064:Speech Disorders / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D014741:Video Recording / Q000379:methods*; D055815:Young Adult