• Title/Summary/Keyword: velopharyngeal insufficiency

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Treatment Results of Tonsil Cancer : Comparison of Extended Tonsillectomy with Composite Resection (편도암의 수술적용 형태에 따른 치료효과 - 광범위 편도절제술과 복합 편도절제술의 비교 -)

  • Chu Hyung-Ro;Han Seung-Hoon;Kwon Kee-Hwan;Jung Kwang-Yoon;Choi Geon;Choi Jong-Ouck
    • Korean Journal of Head & Neck Oncology
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    • v.15 no.1
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    • pp.35-39
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    • 1999
  • Objectives: The treatment for squamous cell carcinoma of the tonsil remains controversial. Surgery or radiation therapy alone is effective in treating early tonsil cancer, but results with single treatment modality in advanced disease have been disappointing. We retrospectively analyzed 37 patients with advanced squamous cell carcinoma of the tonsil for two treatment modalities in an effort to identify more efficacious therapeutic options. Materials and Methods: From 1990 through 1997, 37 patients who were treated primarily with surgery, were retrospectively sudied. The patients were grouped into two groups according to the method of treatment, extended tonsillectomy followed by irradiation and/or postradiation neck dissection(Group I) and a combination of composite resection and postoperative radiation(Group II). Results: The three year disease-tree survival in patients with stage IV lesions was 59.09% for the Group I patients, and 56.25% for the Group II patients. This difference was not statistically significant(p=0.775). The primary tumor recurrence rate in Group I was 16.7% in contrast to 23.1% for Group II. The local recurrence rate in the neck was 16.7% for the Group I patients and 23.1% for the Group II patients. There was no significant difference in the frequency of recurrences in the primary or neck in the patients treated with extended tonsillectomy or composite resection(p=0.639). Fistula formation and aspiration occurred in four patients after composite resection. Additionally, there were three trismus, one soft tissue necrosis, and one velopharyngeal insufficiency. Major complications were not observed in the patients treated with extended tonsillectomy and irradiation: velopharyngeal insufficiency was observed in eight patients and soft tissue necrosis in two patients. Conclusion: Extended tonsillectomy followed by irradiation may be an effective therapy with low morbidity in selected patients with tonsil cancer.

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A study on recognition improvement of velopharyngeal insufficiency patient's speech using various types of deep neural network (심층신경망 구조에 따른 구개인두부전증 환자 음성 인식 향상 연구)

  • Kim, Min-seok;Jung, Jae-hee;Jung, Bo-kyung;Yoon, Ki-mu;Bae, Ara;Kim, Wooil
    • The Journal of the Acoustical Society of Korea
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    • v.38 no.6
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    • pp.703-709
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    • 2019
  • This paper proposes speech recognition systems employing Convolutional Neural Network (CNN) and Long Short Term Memory (LSTM) structures combined with Hidden Markov Moldel (HMM) to effectively recognize the speech of VeloPharyngeal Insufficiency (VPI) patients, and compares the recognition performance of the systems to the Gaussian Mixture Model (GMM-HMM) and fully-connected Deep Neural Network (DNNHMM) based speech recognition systems. In this paper, the initial model is trained using normal speakers' speech and simulated VPI speech is used for generating a prior model for speaker adaptation. For VPI speaker adaptation, selected layers are trained in the CNN-HMM based model, and dropout regulatory technique is applied in the LSTM-HMM based model, showing 3.68 % improvement in recognition accuracy. The experimental results demonstrate that the proposed LSTM-HMM-based speech recognition system is effective for VPI speech with small-sized speech data, compared to conventional GMM-HMM and fully-connected DNN-HMM system.

Functional Reconstruction of the Oral Cavity with Radial Forearm Free Flap

  • Kim, Min-Sik
    • 대한두경부종양학회:학술대회논문집
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    • 2007.05a
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    • pp.80-84
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    • 2007
  • Background and Objectives : The radial forearm free flap is a useful reconstructive method of surgical defects after oral and oropharyngeal tumor resection. We evaluated the swallowing and speech outcomes of radial forearm free flap reconstruction for oral and oropharyngeal cancers. Materials and Methods : We retrospectively reviewed clinical data of 84 patients who underwent reconstructive surgery for oral or oropharyngeal cancer using radial forearm free flap from August 1994 to January 2007. Modified barium swallowing (MBS) was done in 100 patients and speech-language assessment was done in 23 patients by a speech-language pathologist. Results were analyzed according to the swallowing functions and the speech-language assessments. Results : According to the results of MBS which was done postoperatively, aspiration occurred in three patients and velopharyngeal insufficiency occurred in four patients who had been reconstructed with multilobed free flap due to large mucosal defects. There was one patient who exhibited severe articulation impairment out of 23 patients. However, 19 patients out of 23 patients showed excellent intelligibility in speech. Conclusion : We concluded that the radial forearm free flap technique is an excellent reconstructive method for the restoration of palatal and pharyngeal function in oral and oropharyngeal cancer patients.

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A Case of the Soft Palate Reconstruction Using the Bilateral Palatal Mucomuscular Flap and Pharyngeal Flap after Wide Resection (연구개 및 구개수 암종의 광범위 절제 및 국소 점막근 피판 재건술 1예)

  • Gu, Ga Young;Lee, Hye Ran;Jang, Jeon Yeob
    • Korean Journal of Head & Neck Oncology
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    • v.38 no.1
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    • pp.31-35
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    • 2022
  • The soft palate of carcinoma limited to the uvular region is infrequent among oropharyngeal cancers. The oropharynx regulates swallowing and speech through dynamic motions. Failure to reconstruct after surgical resection of the oropharynx structure can lead to permanent velopharyngeal insufficiency. Therefore, suitable reconstruction is important in establishing proper functional outcomes while maintaining oncological safety. We present a case of a 66-year-old male who was diagnosed with oropharynx cancer limited in the uvula accompanied by lymph node metastasis. After surgical resection, reconstruction was performed with the united arrangement of bilateral palatal mucomuscular flap and superiorly based posterior pharyngeal flap. There was no aspiration or reflux after feeding and epithelialization completely occurred after 1 month postoperatively. We report a successful case that the reconstruction with the local flap described above could preserve proper oropharyngeal function after primary surgery in small-sized oropharyngeal cancer.

Prosthetic rehabilitation by double-processing technique for edentulous patient with soft palate defect after maxillectomy: A case report (연구개를 포함한 상악골 절제술을 받은 완전 무치악 환자에서 이중 온성법으로 제작한 구개 폐색장치를 통한 보철수복: 증례 보고)

  • Park, Jin-Yong;Wang, Yuan-Kun;Song, Kwang-Yeob;Park, Ju-Mi;Lee, Jung-Jin
    • The Journal of Korean Academy of Prosthodontics
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    • v.57 no.4
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    • pp.356-363
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    • 2019
  • A patient who went through maxillectomy can have soft palate defects including oronasal fistulas and suffer from dysphagia and dysarthria due to velopharyngeal insufficiency. This defect causes the food to enter nasal cavity and creates hypernasal sound which debilitates a quality of life. An obturator can rehabilitate the substantial oral tissue defects. The maxillary obturator separates the nasopharynx from the oropharynx during speech and deglutition by closing of the defect. For edentulous obturator patient, it is difficult to obtain proper retention due to reduced peripheral sealing. Therefore, the contours of the defects must be used to maximize the retention, stability, and support. Hollow type obturator can improve physiologic function by reducing weight than the traditional obturator. This case report describes a patient with hemi-maxillectomy who recovers mastication, speech, deglutition, and appearance with a maxillary obturator using physiological border molding of the velopharyngeal area and double-processing method.

Analysis of maxillofacial prosthetics at university dental hospitals in the capital region of Korea

  • Kim, Jee-Hwan;Shin, Soo-Yeon;Paek, Janghyun;Lee, Jong-Ho;Kwon, Ho-Beom
    • The Journal of Advanced Prosthodontics
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    • v.8 no.3
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    • pp.229-234
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    • 2016
  • PURPOSE. The purpose of this study was to investigate the demographic patterns of maxillofacial prosthetic treatment to identify the characteristics and geographic distribution of patients with maxillofacial prosthetics in the capital region of Korea. MATERIALS AND METHODS. This retrospective analytical multicenter study was performed by chart reviews. This study included patients who visited the department of prosthodontics at four university dental hospitals for maxillofacial prosthetic rehabilitation. Patients with facial and congenital defects or with insufficient medical data were excluded. The patients were classified into three categories based on the location of the defect. Patients' sex, age, and residential area were analyzed. Pearson's chi-square test with a significance level of 0.05 was used to analyze the variables. RESULTS. Among 540 patients with maxillofacial prosthetics, there were 284 (52.59%) male patients and 256 (47.41%) female patients. The number of the patients varied greatly by hospital. Most patients were older than 70, and the most common defect was a hard palate defect. Chi-square analysis did not identify any significant differences in sex, age, and distance to hospital for any defect group (P>.05). CONCLUSION. The results of this study indicated that there was imbalance in the distribution of patients with maxillofacial prosthetic among the hospitals in the capital region of Korea. Considerations on specialists and insurance policies for the improvement of maxillofacial prosthetics in Korea are required.

CLINICAL STUDY OF SURGICAL TREATMENTS ON CLEFT LIP AND CLEFT PALATE (순열 및 구개열 환자의 외과적 치료방법에 관한 임상적 연구)

  • Shin, Byung-Chol;Lee, Dong-Keun;Sung, Gil-Hyun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.18 no.4
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    • pp.529-545
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    • 1996
  • In order to find the distribution, causes and treatments of cleft lip and/or palate, I analyzed 113 patients of cleft lip and/or palate who were treated in the Department of Oral and Maxillofacial Surgery, School of Dentistry, Wonkwang University, Iksan, Chunbuk, KOREA from September 1984 to August 1995. The obtained results were as follows. 1. In total 113 patients of cleft lip and/or palate, male patients were 63 cases (56%) and female patients were 50 cases (44%). 2. In distribution of cleft lip and/or palate, cleft lip patients were 30 cases (27%), cleft palate patient were 23 cases (20%) and cleft lip and palate patients were 60 cases (53%). 3. Unilateral cleft lip patients (78 cases: 87%) were larger than bilateral cleft lip. In unilateral cleft lip patients, lip side cleft lip patients (45 cases: 50%) were larger than right side cleft lip patients (33 cases: 37%). 4. Possible causes of cleft lip and/or palate were related with familial tendency, drug intoxication, malnutrition, old maternal age, stress and hypoxia during 4-8 weeks of pregnancy period. 5. The favorite treated method of cleft lip was Millard rotation-advancement method. Probably the most popular operated period was 3 months. 6. The useful operating technique of cleft palate was Wardill V-Y flap method. The most popular period has been 18 to 24 months. 7. In 11 patients with velopharyngeal insufficiency, hypernasality decreased by superior based pharyngeal flap pharyngoplasty. 8. Cleft alveolus was treated with autogenous and allogeneic bone graft. The most appropriate operation period was 9 to 11 years.

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Clinical interventions and speech outcomes for individuals with submucous cleft palate

  • Jung, Seung Eun;Ha, Seunghee;Koh, Kyung S.;Oh, Tae Suk
    • Archives of Plastic Surgery
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    • v.47 no.6
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    • pp.542-550
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    • 2020
  • Background This study aimed to identify the initial diagnostic characteristics and treatment status of children with submucous cleft palate (SMCP) and to examine the relationship between the timing of surgical correction and the degree of articulation and resonance improvement. Methods This retrospective study included 72 children diagnosed with SMCP between 2008 and 2016. The evaluation criteria were the age of the initial visit, total number of visits, age at the end of treatment, speech problems, resonance problems, and speech therapy. Results Children with SMCP first visited the hospital at an average age of 34.32 months, and speech problems were identified at an average age of 48.53 months. Out of 72 children, 46 underwent surgery at an average age of 49.74 months. Four of these children required secondary surgery at an average age of 83.5 months. Among the children who underwent surgery before 3 years of age, 70% exhibited articulation improvements, with mild-to-moderate hypernasality. Articulation improvements showed no statistically significant differences according to age at the time of surgery. However, children who underwent surgery before 4 years had a better hypernasality rating than those who underwent surgery after 4 years of age. Conclusions Children with SMCP tend to undergo delayed treatment because the anatomical symptoms in some children with SMCP are unclear, and surgical interventions are considered only after speech problems are clarified. Starting interventions as early as possible reduces the likelihood of receiving secondary surgery and speech therapy, while increasing expectations for positive speech function at the end.

A Case of Partial DiGeorge Syndrome in Prematurity (미숙아에서 발견된 부분형 DiGeorge 증후군 1례)

  • Sung, Tae Jung;Ko, Eun Young;Kim, Dal Hyon;Oh, Ji Eun;Kwon, Young Se;Lim, Dae Hyun;Son, Byong Kwan
    • Clinical and Experimental Pediatrics
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    • v.45 no.3
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    • pp.383-389
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    • 2002
  • We experienced a case of partial DiGeorge syndrome in a $35^{+5}$ week premature female infant presented with micrognathia, fish-shaped mouth, beaked nose, nasal regurgitation, obstructive sleep apnea, velopharyngeal insufficiency and late onset hypocalcemic seizures. The chromosome 22q11 microdeletion was found by the FISH method. The lab findings showed serum calcium level of 4.4 mg/dL, ionized calcium level of 0.49 mg/dL, phosphorous level of 7.5 mg/dL, magnesium level of 1.3 mg/dL and PTH-RIA level of <1 pq/mL. Initial treatment was done with 10% calcium gluconate infusion and magnesium sulfate followed by oral calcium gluconate and low phosphorousformula milk feeding. The serum calcium level was normalized in 6 days. Nasal regurgitation, desaturation with obstructive sleep apnea continued. T-cell functions & numbers(CD 3, CD 4, CD 8)were decreased but Ig G/A/M levels were normal. No visible signs of thymus shadow were seen in either chest X-ray & chest MRI. Electrocardiography and echocardiography showed normal heart. Kidney ultrasonographby showed right side mild hydronephrosis. Neurosonography was normal but EEG showed electrical partial seizure. Hearing assessment by BERA showed mild to moderate hearing impairment. Velopharyngoplasty is scheduled for further treatment. A brief review of literature was made.

The treatment of obstructive sleep apnea patient using extended uvulopalatal flap: a case report (폐쇄성 수면무호흡환자에서 확대 구개수구개피판을 이용한 치험례)

  • Kim, Ji-Youn;Kim, Soung-Min;Myoung, Hoon;Hwang, Soon-Jung;Seo, Byoung-Moo;Lee, Jong-Ho;Choung, Pill-Hoon;Kim, Myung-Jin;Choi, Jin-Young
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.37 no.1
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    • pp.81-85
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    • 2011
  • The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstructive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the antero-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF technique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, nasopharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and treated with the EUPF technique. The patient's total respiratory disturbance events per hour (RDI) was decreased to 15.4, the $O_2$ saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.