Portal de Periódicos da CAPES

Video Velopharyngography in Patients with Nasal Speech, with Emphasis on Lateral Pharyngeal Motion in Velopharyngeal Closure

1969; Radiological Society of North America; Volume: 93; Issue: 4 Linguagem: Inglês

10.1148/93.4.747

1527-1315

M. Leon Skolnick,

Craniofacial Disorders and Treatments

The purpose of this paper is to discuss the importance of radiographic examination of the velopharyngeal portal in patients with nasal speech, to present a new technic for evaluating closure of the portal during phonation, and to describe preliminary experience with this technic. A complete appreciation of the clinical problem and the radiographic approach to its solution requires a knowledge of the regional anatomy (1–5). Closure of the velopharyngeal portal during phonation is the result of two types of motion: (a) Midsagittal velopharyngeal contact, a flap valve-like action which occurs when the thick midportion of the velum elevates and moves posteriorly to contact the midpharyngeal wall. This motion results from the combined contractions of the levator palati and palatopharyngeus muscles. (b) Medial motion of localized regions of both lateral pharyngeal walls against the edges of the velum to close the lateral aspects of the velopharyngeal portal. These movements result from contraction of fibers of the superior constrictors that insert bilaterally into the velar aponeurosis and the palatal pharyngeus muscles. The salpingopharyngeus muscle is also believed to aid in this motion (Fig. 1). In normal subjects, both component motions of the closure mechanism must operate together to prevent the nasal emission of sound. When the velopharyngeal portal does not close satisfactorily during the utterance of non-nasal sounds, acoustic energy escapes into the nasal cavity and gives speech a nasal quality. Evaluation of the degree and location of the incompetence of this portal requires visualization of the margins of the portal in motion during a wide range of speech. If the portal is visually inspected through the open mouth, either directly or within an intraoral scope, the sounds that can be uttered will be limited and distorted by the open-mouth position and by the examining equipment. Only radiographic technics can visualize the dynamics of closure without producing speech artifacts. Furthermore, simultaneous recording of the roentgen image and patient speech in at least the frontal and lateral views is necessary for adequate evaluation, the frontal view demonstrating medial motion of the lateral walls and the lateral view showing midsagittal contact. Prior roentgen motion studies of the velopharyngeal portal during phonation have almost always been in the lateral projection. Ciné both with (6–8) and without (9–12) simultaneous voice recording has been used, as well as video tape recordings of the fluoroscopic image and voice together (13). A technic for recording oblique views of the velopharyngeal portal on ciné to distinguish the right and left side has also been described (14). Technic 1. The patient is seated in a specially constructed chair having a radiotransparent back and a device to immobilize the head. An opaque ruler is placed in the midline under the chin to measure midsagittal structures directly from the kinescope.