Understanding Access to Care: Factors Influencing Patient Attendance at Craniofacial Speech Evaluations.

Evaluate predictors for attendance and adherence to speech evaluations and determine factors that influence longitudinal care for patients with cleft palate and craniofacial differences. Retrospective, observational cohort study. Tertiary children's hospital.

Differential Diagnosis of a Pharyngeal Fricative and Therapeutic Monitoring of Velopharyngeal Function Using Magnetic Resonance Imaging.

Purpose: Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active).

Levator Veli Palatini Muscle Ratio Is a Clinically Significant Anatomic Predictor for Velopharyngeal Surgical Need.

Objective: Velopharyngeal insufficiency (VPI) poses challenges for normal speech production, often necessitating surgical intervention. Determining optimal candidates for surgery remains complex and requires a nuanced understanding of underlying anatomic factors contributing to VPI. This study aimed to identify anatomic predictors that drive surgical recommendations for VPI.

A Computational Model Reveals How Varying Muscle Activation in the Lateral Pharyngeal Wall and Soft Palate Differentiates Velopharyngeal Closure Patterns.

Purpose: Finite element (FE) models have emerged as a powerful method to study biomechanical complexities of velopharyngeal (VP) function. However, existing models have overlooked the active contributions of the lateral pharyngeal wall (LPW) in VP closure. This study aimed to develop and validate a more comprehensive FE model of VP closure to include the superior pharyngeal constrictor (SPC) muscle within the LPW as an active component of VP closure.

Achieving Clinical Success in Nonsedated Velopharyngeal MRI: Insights for Optimal Data Quality & Effective Patient Selection.

Background: The ability of MRI for in vivo visualization of the velopharyngeal (VP) musculature makes it the only imaging modality for this purpose. This underscores a need for exploration into clinical translation of this imaging modality on craniofacial teams. The purpose of this study was to assess outcomes of a clinically feasible VP MRI protocol and describe the ideal patient population for utilization of this imaging protocol.

Measurement Matters: MRI Analysis of Differing Anatomic Measurement Techniques for Velar Length and the Velopharyngeal Needs Ratio.

Background: Advances in imaging tools provide opportunities to enhance how velopharyngeal (VP) variables are quantified to facilitate surgical decisions. The purpose of this study was to use magnetic resonance imaging (MRI) to determine if quantitative differences were present between measures of linear and curvilinear velar length, and subsequently, the VP needs ratio.

Methods: Data were prospectively collected from patients presenting with repaired cleft palate and/or congenital palatal insufficiency with or without VPI at a single center tertiary children's hospital.

Continuing Education Needs of Speech-Language Pathologists for Assessing and Treating Children With Cleft Palate: A National Analysis Across Areas of Varying Population Density.

Purpose: The purpose of this study was to identify training gaps and continuing education (CE) needs for speech-language pathologists (SLPs) in evaluating and treating children with cleft palate across and among areas of varying population density.

Method: An anonymous 35-question survey lasting approximately 10-15 min was created in Qualtrics based on a previously published study. The survey information and link were electronically distributed to American Speech-Language-Hearing Association (ASHA)-certified SLPs through ASHA listservs, social media, individual-state SLP organizations, and an e-mail list of publicly listed SLPs.

Where is the Care? Identifying the Impact of Rurality on SLP Caseloads and Treatment Decisions for Children with Cleft Palate.

Challenges providing cleft/craniofacial care in rural communities are often reported, leading to disparities in resources available to clinicians. The purpose of this study was to identify the impact of rurality on caseloads and practice patterns of speech-language pathologists (SLPs) regarding speech and velopharyngeal function for children with cleft lip and/or palate (CL/P). A national, survey of US-based SLPs (N = 359 respondents) investigated resources, comfort level, caseloads, and practice patterns for children with CL/P.

Incorporating Velopharyngeal MRI into the Clinical Decision-Making Process for a Patient Presenting with Velopharyngeal Dysfunction Following a Failed Palatoplasty.

This clinical report describes the implementation of magnetic resonance imaging (MRI) to evaluate a patient with long-standing velopharyngeal dysfunction. She was referred to the craniofacial clinic at age 10 with no prior surgical history and subsequently completed a Furlow palatoplasty due to a suspected submucous cleft palate. However, results were unfavorable with minimal improvement in speech or resonance.

Magnetic Resonance Imaging for Assessing Velopharyngeal Function: Current Applications, Barriers, and Potential for Future Clinical Translation in the United States.

Objective: The use of magnetic resonance imaging (MRI) in the assessment process for children with cleft/craniofacial conditions remains uncommon, particularly for velopharyngeal assessments. The purpose of this study was to analyze the perceived clinical utility of MRI for cleft/craniofacial providers and identify barriers that exist for clinical translation of this imaging modality to this population of patients.

Methods: A 38-item survey was disseminated to craniofacial team providers.

Simulation of Velopharyngeal Biomechanics Identifies Differences in Sphincter Pharyngoplasty Outcomes: A Matched Case-Control Study.

The purpose of this study was to develop a framework for 3D subject-specific computational models capable of simulating velopharyngeal biomechanics for anatomic changes that occur following pharyngoplasty and to gain insight into biomechanical factors that may lead to different speech/surgical outcomes. Patient-specific models for two, matched participants with differing speech/surgical outcomes were developed: one with a successful pharyngoplasty outcome and one with a failed pharyngoplasty outcome. Surgical scenarios were simulated to model pharyngoplasty location, identify LVP muscle biomechanics, and identify an optimal pharyngoplasty location for each participant.

Utilization of 3D MRI for the Evaluation of Sphincter Pharyngoplasty Insertion Site in Patients With Velopharyngeal Dysfunction.

Sphincter pharyngoplasty is a surgical method to treat velopharyngeal dysfunction. However, surgical failure is often noted and postoperative assessment frequently reveals low-set pharyngoplasties. Past studies have not quantified pharyngoplasty tissue changes that occur postoperatively and gaps remain related to the patient-specific variables that influence postoperative change.

Does the Type of MRI Sequence Influence Perceived Quality and Measurement Consistency in Investigations of the Anatomy of the Velopharynx?

Purpose: The purpose of this study was to evaluate perceived image quality, confidence in identifying key velopharyngeal landmarks, and reliability of making velopharyngeal measures between 3-dimensional (3-D) and 2-D magnetic resonance imaging (MRI) methods and between T1-, T2-, and proton density (PD)-weighted sequences.

Methods: Twelve healthy participants completed an MRI study. Three raters assessed overall image quality and their ability to identify key anatomic features within the images.

English-Only Treatment of Compensatory Speech Errors in a Bilingual Adoptee With Repaired Cleft Palate: A Descriptive Case Study.

Purpose The purpose of this clinical focus article is to provide a descriptive case study of a late-adopted, bilingual adolescent with cleft palate speech errors. Specifically, we examined the cross-linguistic generalization of remediated compensatory cleft errors, following treatment in English (second language) only. The overarching goal of this study is to gain insights into the complexity of speech intervention for the adopted population with delayed cleft palate repair.

Evaluating the Accuracy of Using at Rest Images to Determine the Height of Velopharyngeal Closure.

Prior to performing secondary surgeries, lateral cephalograms have been used during phonation to evaluate the point of attempted velopharyngeal contact along the posterior pharyngeal wall relative to the palatal plane and the first cervical vertebra. The ability to quantify the height of velopharyngeal closure is an important aspect of planning corrective surgeries for velopharyngeal dysfunction. However, issues with patient compliance during the imaging process can present difficulties for obtaining adequate preoperative imaging data.

Effect of motor-based speech intervention on articulatory placement in the treatment of a posterior nasal fricative: a preliminary MRI study on a single subject.

Background: Posterior nasal fricatives are a learned compensatory articulation error and commonly substituted for oral fricatives. Treatment of such articulation errors requires the modification or teaching of skilled movements. A motor-based approach is designed to teach the complex motor skill movement sequences required in the production of sounds.

Can Dynamic MRI Be Used to Accurately Identify Velopharyngeal Closure Patterns?

Background: Dynamic magnetic resonance imaging (MRI) has been proposed as a non-invasive, child-friendly, reproducible, and repeatable imaging method providing a 3-dimensional view of the velopharyngeal structures and function during speech. However, the value of dynamic MRI as compared to imaging methods such as nasopharyngoscopy is not well understood. The aim of this study was to compare the ability of nasopharyngoscopy and dynamic MRI to accurately identify velopharyngeal closure patterns among adults without cleft palate.

Changes in the Height of Velopharyngeal Closure Relative to the Cervical Spine From Infancy Through Adolescence in Patients With Cleft Palate.

Objective: Palpation is often used to identify C1, an intraoperative landmark, for placement of the pharyngoplasty. However, little is known about the relationship between the palatal plane (PP) and this cervical spine landmark across select variables. This study seeks to analyze variations in the height of velopharyngeal closure relative to C1 across differing cleft types and age groups.

Relationship Between Age and Diagnosis on Volumetric and Linear Velopharyngeal Measures in the Cleft and Noncleft Populations.

The purpose of this study was to create a 3D volumetric segmentation from magnetic resonance imaging (MRI) of the nasopharyngeal space and adenoid tissue and to examine the relationship between nasopharyngeal volume (NPV), adenoid volume, and linear measures of the velopharyngeal structures, pharynx, and vocal tract in children with and without cleft palate. A total of 24 participants including 18 typically developing children (4-8 years of age) and 6 children (4-8 years of age) with varying degrees of cleft palate were imaged using MRI. Linear and volumetric variables varied significantly based on age.

Age-Related Changes Between the Level of Velopharyngeal Closure and the Cervical Spine.

The primary focus of this study was to assess age-related changes in the vertical distance of the estimated level of velopharyngeal closure in relation to a prominent landmark of the cervical spine: the anterior tubercle of cervical vertebra 1 (C1). Midsagittal anatomic magnetic resonance images were examined across 51 participants with normal head and neck anatomy between 4 and 17 years of age. Results indicate that age is a strong predictor (P = 0.

Sphincterplasty for Velopharyngeal Insufficiency in the Child Without a Cleft-Palate: Etiologies and Speech Outcomes.

The aim of this study is to report on speech outcomes following surgery for velopharyngeal insufficiency (VPI) on a broad spectrum of patients without a cleft palate. Inclusion criteria included patients without a cleft palate operated on by a single surgeon (JKW) over a 10-year period and postoperative speech evaluation within 1 year. All patients underwent a sphincter pharyngoplasty.