Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency.
BACKGROUND
One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI).


OBJECTIVE
This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate.


METHODS
An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy.


RESULTS
Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented.


CONCLUSIONS
This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management.
Speech and Language Pathology Services, Ian Jackson Craniofacial and Cleft Palate Clinic-Neuroscience Program, Beaumont Health System, 3535 West 13 Mile Road, Royal Oak, MI 48073, USA.
Pablo Antonio
PA
Ysunza
Center for Genetics and Genomics, Facultad de Medicina, Clinica Alemana, Universidad del Desarrollo, Avenida Las Condes 12438, 7710162 Santiago, Chile ; Hospital Padre Hurtado, Avenida Esperanza 2150, San Ramon, 8880465 Santiago, Chile.
Gabriela M
GM
Repetto
Cleft Palate Clinic, Hospital Gea Gonzalez, Calzada Tlalpan 4800, 14000 Mexico City, DF, Mexico.
Maria Carmen
MC
Pamplona
Center for Genetics and Genomics, Facultad de Medicina, Clinica Alemana, Universidad del Desarrollo, Avenida Las Condes 12438, 7710162 Santiago, Chile.
Juan F
JF
Calderon
Ian Jackson Craniofacial and Cleft Palate Clinic, Neuroscience Progra, m Beaumont Health System, 3535 West 13 Mile Road, Royal Oak, MI 48073, USA.
Kenneth
K
Shaheen
Ian Jackson Craniofacial and Cleft Palate Clinic, Neuroscience Progra, m Beaumont Health System, 3535 West 13 Mile Road, Royal Oak, MI 48073, USA.
Konkgrit
K
Chaiyasate
Ian Jackson Craniofacial and Cleft Palate Clinic, Neuroscience Progra, m Beaumont Health System, 3535 West 13 Mile Road, Royal Oak, MI 48073, USA.
Matthew
M
Rontal
D002972:Cleft Palate / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control*; D006801:Humans; D013064:Speech Disorders / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D063189:Symptom Assessment / Q000379:methods; D014681:Velopharyngeal Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*